Automatic surgical ligation clip applier

ABSTRACT

An applier for ligation clip is provided. The applier includes: an outer tube having mounting bosses; a pair of jaws pivotally connected to the mounting bosses, the jaws having actuating projections; a feed tube located in the outer tube and configured to move axially within the outer tube, the feed tube having actuating slots in which the actuating projections are located; a clip lock arm located in the outer tube and configured to move axially within the outer tube; and a clip advance arm located in the outer tube and configured to move axially within the outer tube, the clip advance arm having flexible pinchers at one end of the clip advance arm. A method of applying a ligation clip is also disclosed.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a Divisional Application of pending U.S. patentapplication Ser. No. 13/618,215, filed Sep. 14, 2012, which claimspriority to provisional U.S. patent application entitled, AutomaticSurgical Ligation Clip Applier, filed Sep. 15, 2011, now expired, havinga Ser. No. 61/535,166, the disclosures of which are hereby incorporatedby reference in their entirety.

FIELD OF THE INVENTION

The present invention relates to medical devices and, in particular, adevice for applying surgical clips for ligation of vessels or tissue.

BACKGROUND

Many surgical procedures require vessels or other fluid ducts or tissueconduits and structures to be ligated during the surgical process, suchas, for example, veins or arteries in the human body. For example, manysurgical procedures require cutting blood vessels, and these bloodvessels may require ligation to reduce bleeding. In some instances, asurgeon may wish to ligate the vessel temporarily to reduce blood flowto the surgical site during the surgical procedure. In other instances asurgeon may wish to permanently ligate a vessel. Ligation of vessels orother tissues can be performed by closing the vessel with a ligatingclip, or by suturing the vessel with surgical thread. The use ofsurgical thread for ligation requires complex manipulations of theneedle and suture material to form the knots required to secure thevessel. Such complex manipulations are time-consuming and difficult toperform, particularly in endoscopic surgical procedures, which arecharacterized by limited space and visibility. By contrast, ligatingclips are relatively easy and quick to apply. Accordingly, the use ofligating clips in endoscopic as well as open surgical procedures hasgrown dramatically.

Various types of hemostatic and aneurysm clips are used in surgery forligating blood vessels or other tissues to stop the flow of blood. Suchclips have also been used for interrupting or occluding ducts andvessels in particular surgeries such as sterilization procedures.Typically, a clip is applied to the vessel or other tissue by using adedicated mechanical instrument commonly referred to as a surgical clipapplier, ligating clip applier, or hemostatic clip applier. Generally,the clip is left in place after application to the tissue untilhemostasis or occlusion occurs.

Ligating clips can be classified according to their geometricconfiguration (e.g., symmetric clips or asymmetric clips), and accordingto the material from which they are manufactured (e.g., metal clips orpolymeric clips). Symmetric clips are generally “U” or “V” shaped andthus are substantially symmetrical about a central, longitudinal axisextending between the legs of the clip. Symmetric clips are usuallyconstructed from metals such as stainless steel, titanium, tantalum, oralloys thereof. But, with the advent of high technology diagnostictechniques using computer tomography (CATSCAN) and magnetic resonanceimaging (MRI), metallic clips have been found to interfere with theimaging techniques. To overcome such interference limitations,biocompatible polymers have been increasingly used for surgical clips.

Some well known polymeric clips are disclosed in U.S. Pat. No. 4,834,096and U.S. Pat. No. 5,062,846. These plastic clips generally comprise apair of curved legs joined at their proximal ends with an integral hingeor heel, and a closure or locking mechanism at their distal ends.Another example of a bio-compatible clip is shown in U.S. Pat. No.4,671,281, which includes a mechanism to be actuated on a proximal endof the clip for causing the distally extending legs of the clip toconverge. However this clip is: (i) rudimentary in construction, (ii)does not provide adequate clip closing or clamping strength, (iii) lacksany complex geometry which would adequately retain the clip in a closedposition, and further (iv) is too unstable when closed to be safelyapplied over vessels. Examples of metal hemostatic clips are shown inU.S. Pat. No. 3,326,216 and U.S. Pat. No. 5,908,430.

In all of the known ligating clips however, there remains a need toimprove the effectiveness of clamping about a vessel, while minimizingthe damage to the vessel and surrounding tissue. For endoscopic surgicalprocedures, it is important to use tools and instruments that have thesmallest, narrowest profile possible, such as the shafts of a tubularendoscope. Prior art polymeric and metal clips do not lend themselves todeployment through small diameter instrumentation, such as, for example,a ˜5 mm endoscope. Known prior art clips can be very wide profile,especially when in the open position prior to closure and ligation, andthus require larger, wider endoscopic instruments and appliers for usein surgery. It is desirable therefore to provide for a surgical ligationclip that has the narrowest profile possible. It may also be desirableto allow for a clip to be opened again after initial closure, which isespecially a problem with known surgical clips, such as metal hemostaticclips. Furthermore, prior art polymeric clips involve locking the distalends of their legs together in order to clamp down on the vessel orstructure being ligated. Such closure of a clip having locking parts atits distal end generally causes or requires dissection, removal, orclearance of additional surrounding tissue, in order to allow the clip'slocking features to come together, and/or due to actuation of an appliertool surrounding or applied against the distal clip ends, requiringadditional time during a surgical procedure and damage to tissue. Inother cases, the user may choose not to prepare a path for the lockingfeatures and rely on the locking features penetrating through thetissue. In these cases, the locking feature may have difficultypenetrating the tissue or may have difficulty locking after it haspenetrated the tissue. This technique may also result in unintendedpenetration of tissue or vessels.

Therefore it is desirable to provide a clip and a method and/or devicefor applying the clip which minimizes such dissection of tissue duringapplication. It is further desirable to provide a clip which provides aproper, well-calibrated, reliable clamping force, such that the clipwhen closed is stable around the vessel ligated.

Accordingly, there is a need to provide an improved surgical ligatingclip and a method and/or device for applying the clip, where the clipserves to reliably secure the tissue or vessel engaged by the clip,while robustly remaining attached to the vessel with a minimum level ofdamage to tissue.

SUMMARY OF THE INVENTION

The invention provides, in one or more embodiments, a surgical ligationclip and a device and/or a method of applying the clip to a vessel ortissue. The device may contain a plurality of clips and may apply afirst clip to a vessel or tissue and advance a second clip contained inthe applier to an applying position.

In another aspect of the invention, a method of applying a surgicalligation clip includes positioning the clip in an open positionproximate an inner anatomical body vessel, the clip having first andsecond legs each extending along a longitudinal axis of the clip andhaving proximal and distal end portions with respect to saidlongitudinal axis, a clip hinge means joining the first and second legsat a point on their respective proximal end portions, the first andsecond legs each having inner clamping surface means between the cliphinge and the distal end portions of said first and second legs, theclamping surface means being apposed when the clip is in a fully closedposition, and a locking means for biasing the legs closed extendingproximal to the clip hinge means. An external force is appliedsubstantially along the longitudinal axis to a proximal end portion ofone of the legs which forms a portion of the locking means, to move abody formed as a first part of said locking means from a first positionto a second position to provide an abutment force between a curvedplanar segment abutment portion of said body and a curved surface formedon a second part of said locking means disposed on the first leg to biasthe clip in a closed position. The method may further include moving theclip through an instrument prior to positioning the clip proximate thevessel, and may also further include that a portion of the instrumentopens the clip from a closed position to an open position.

The applier is an instrument used to deploy multiple proximal lockingpolymeric ligation clips, the number of clips within the applier isproportional to the length the distal end of the applier and the lengthof the clip. The automatic applier applies a single clip at a time withthe ability to repeat the application multiple times without moving fromthe surgical site. The applier is an endoscopic instrument suitable foruse in laparoscopic surgery applications.

The jaws of the applier will be able to actuate without disturbing theloaded clip. This allows the jaws to be used in the dissection andgrasping of tissue around the vessel being ligated if necessary.

In one embodiment of the invention; the jaws of the applier will clampover the vessel to flatten the section to be ligated. The clip is openedinternally in the applier by a set of wedges. The clip is thenpositioned over the vessel and subsequently closed with actuation of thewedges and final pusher mechanisms. The clip is then closed with thewedges and a second clip, proximal to the first clip, engages thelocking feature on the first clip and locks the clip to maintain theclamping pressure of the clip. The jaws then open allowing the ligatedvessel and clip to clear the applier jaws. The internal components ofthe applier return to their start positions and the second clip becomesthe first clip. This repeats until the applier is out of clips. The lastclip is locked with a false clip that stays internal to the applier.When all clips have been delivered the false clip assists with thehandle lockout which prevents the user from being able to use theligation portion of the applier. The jaws continue to actuate.

In one embodiment of the invention; the jaws of the applier will clampover the vessel to flatten the section to be ligated. The clip is pushedthrough a channel and into a set of doors with features on the undersidethat opens the clip. The clip is then positioned partially over thevessel with forward movement of the channel and clip advancers. Themovement stops and the clip is advanced fully over the vessel with theclip advancers, at this time the clip is pushed out of the doors. Thedoors swing together and become the surface that is used to latch theclip. With the doors closed the channel continues forward and latchesthe clip. The jaws then open allowing the ligated vessel and clip toclear the applier jaws. The internal components of the applier return totheir start positions and the second clip becomes the first clip. Thisrepeats until the applier is out of clips.

Each of the distal end actuations are accomplished through the use of aproximal handle. The handle is made of a housing and rotation knob,which allow for a 360° continuous rotation of the distal end, separatetriggers for jaw actuation and clip functions, and a multi-stagetransmission that allows the distal end to be actuated in the propersequence for effective clip delivery.

In one embodiment, the applier has a transmission that has at least twoinputs. the inputs are manipulated by a jaw actuation trigger and a clipfunction or ligate trigger. The transmission is connected to clipadvancers and the jaws of the applier and transform the triggerpositions to articulations of the jaws and/or the clip advancers.

In one embodiment, a method of moving clips through an applier,attaching a clip to a vessel or tissue is provided.

In an embodiment, an applier for ligation clip is provided. The applierincludes: an outer tube having mounting bosses; a pair of jaws pivotallyconnected to the mounting bosses, the jaws having actuating projections;a feed tube located in the outer tube and configured to move axiallywithin the outer tube, the feed tube having actuating slots in which theactuating projections are located; a clip lock arm located in the outertube and configured to move axially within the outer tube; and a clipadvance arm located in the outer tube and configured to move axiallywithin the outer tube, the clip advance arm having flexible pinchers atone end of the clip advance arm.

In an embodiment, a method of applying a ligation clip includes:slidinga feed tube forward thereby camming a projection on a jaw to move thejaw to an open position; sliding a clip arm forward thereby pushing aclip into the jaws;

sliding the feed tube rearward thereby camming the projection on the jawto move the jaw to a closed position; and advancing a clip arm to aforward position to push a buttress on the clip into a buttress lockingvoid thereby locking the clip and a closed position.

In an embodiment, an applier for ligation clip may include: an outertube having mounting bosses; means for clamping pivotally connected tothe mounting bosses, the means for clamping having actuatingprojections; means for opening and closing the means for clampinglocated in the outer tube and configured to move axially within theouter tube, the means for opening and closing the means for clampinghaving actuating slots in which the actuating projections are located;means for locking a clip in closed position located in the outer tubeand configured to move axially within the outer tube; and means foradvancing a clip located in the outer tube and configured to moveaxially within the outer tube.

There has thus been outlined, rather broadly, certain embodiments of theinvention in order that the detailed description thereof herein may bebetter understood, and in order that the present contribution to the artmay be better appreciated. There are additional embodiments and featuresof the invention that will be described below.

In this respect, before explaining at least one embodiment of theinvention in detail, it is to be understood that the invention is notlimited in its application to the details of construction and to thearrangements of the components set forth in the following description orillustrated in the drawings. The invention is capable of embodiments inaddition to those described and of being practiced and carried out invarious ways. Also, it is to be understood that the phraseology andterminology employed herein, as well as the abstract, are for thepurpose of description and should not be regarded as limiting.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a view of a first embodiment of a surgical ligation clip ofthe present invention;

FIGS. 2a, 2b, and 2c show side, top, and bottom views respectively, ofthe clip shown in FIG. 1;

FIGS. 3 and 4 show perspective views of the clip shown in FIG. 1 from afirst side;

FIG. 5 shows a perspective view of the clip shown in FIG. 1 from theside opposite to that shown in FIGS. 3 and 4;

FIG. 6 is another side view of the clip shown in FIG. 1;

FIG. 6a is a close-up detail view of the portion of the clip shown inFIG. 6 in region “6 a” therein;

FIG. 6b is a sectional view of the clip shown in FIG. 6 taken alongsection B-B in the direction shown in FIG. 6;

FIG. 7 is another side view of the clip shown in FIG. 1 from theopposite side to that shown in FIG. 6;

FIG. 7a is a close-up detail view of the portion of the clip shown inFIG. 7 in region “7 a” therein;

FIG. 7b is a sectional view of the clip shown in FIG. 7 taken alongsection C-C in the direction shown in FIG. 7;

FIGS. 8a, 8b, and 8c , are side, top, and bottom views, respectively, ofthe clip shown in FIG. 1 in an open position;

FIG. 9 is a perspective view from the bottom of the clip shown in FIG.8a in the open position;

FIG. 10 is a perspective side view from the top of the clip shown inFIG. 8a in the open position;

FIGS. 11a, 11b, and 11c show side, top, and bottom views respectively,of the clip shown in FIG. 1, with the proximal locking components inlocked position;

FIG. 12 is a perspective view from the top of the clip shown in FIG. 11a;

FIG. 13 is a side view of the clip shown in FIG. 11 a;

FIG. 13a is a close-up detail view of the portion of the clip shown inFIG. 13 in region “13 a” therein;

FIG. 14 is a side view of the clip shown in FIG. 11a from the sideopposite to that shown in FIG. 13;

FIG. 14a is a close-up detail view of the portion of the clip shown inFIG. 14 in region “14 a” therein;

FIG. 15 is a view of the clip shown in FIG. 1;

FIG. 15a is a close-up detail view of the portion of the clip shown inFIG. 15 in region “15 a” therein;

FIG. 16 shows a side view of an applier;

FIG. 17 shows a isometric view of clip latched on vessel;

FIG. 18 shows a clip latched on vessel;

FIG. 19 shows an applier approach to vessel;

FIG. 20 shows an applier clamped on vessel;

FIG. 21 shows a feed rail;

FIG. 22 shows a wedge;

FIG. 23 shows a primary pusher;

FIG. 24 shows a final pusher;

FIG. 25 shows an inner tube;

FIG. 26 shows an outer tube;

FIG. 27 shows a jaw/inner tube camming;

FIG. 28 shows a jaw/inner tube cam points;

FIGS. 29-31 shows jaws;

FIG. 32 shows inner and outer tubes cut away to see interior of distalend;

FIG. 33 shows a top feed rail cut away to see clip and wedge;

FIG. 34 shows a final pusher cut away to show primary pusher;

FIG. 35 shows jaws clamped on vessel;

FIG. 36 shows a start of ligation—wedges, primary & final pushers beginto move;

FIG. 37 shows an open clip advanced into jaws over vessel;

FIG. 38 shows wedges advance to close clip legs down on vessel;

FIG. 39 shows a second clip advanced into first clip rotating buttressand locking first clip;

FIG. 40 shows wedges begin to retract, feeder rails are together keepingthe second from retracting;

FIG. 41 wedges continue to retract primary pusher and second clipretract;

FIG. 42 shows second clip stops in notch on feeder rails, wedges andprimary pushers continue to retract final pusher begins to retract;

FIG. 43 shows all moving parts return to start position, first clip onvessel is released when jaws are opened;

FIG. 44 shows a last clip in stack is locked with a false clip;

FIG. 45 shows a false clip;

FIG. 46 shows a dual trigger handle;

FIG. 47 show an isometric view of handle;

FIG. 48 shows a handle with shell and knobs exploded showing actuationmechanisms;

FIG. 49 shows internal handle components;

FIG. 50 shows triggers and mechanisms;

FIGS. 51-58 show a pawl mechanism;

FIG. 59 shows transmission parts;

FIG. 60 shows a multi stage transmission;

FIG. 61 shows a outer shell of transmission removed;

FIG. 62 show a jaw actuation links removed;

FIG. 63 shows a back outer shell removed;

FIG. 64 shows a final pusher latches and dowels removed;

FIG. 65 shows a primary pusher latches removed;

FIG. 66 shows center spindles removed distal end connection pointsshown;

FIG. 67 shows input positions when the jaws are open;

FIG. 68 shows input positions when the jaws are clamped on vessel;

FIG. 69 shows input positions at a start of clip advance;

FIG. 70 shows input positions for a first clip advanced over vessel byfinal pushers and wedges advance second clip advances by primarypushers;

FIG. 71 shows input positions for wedges to advance to close first clip;

FIG. 72 shows input positions for a clip latch—primary pushers advancesecond clip to lock first clip;

FIG. 73 shows input positions for wedges to begin to retract;

FIG. 74 shows input positions for primary pushers to retract and wedgescontinue to retract;

FIG. 75 shows input positions for final pusher to retract other partscontine to retract;

FIG. 76 shows input positions when everything returns to startposition-second clip is now the first clip;

FIG. 77 shows a walking beam;

FIG. 78 shows a walking beam;

FIG. 79 shows a walking beam;

FIG. 80 shows a walking beam pusher;

FIG. 81 shows a walking beam pusher;

FIG. 82 shows a punch ring;

FIG. 83 shows a punch door;

FIG. 84 shows a door wedge;

FIG. 85 shows a clip advancer;

FIG. 86 shows a start position;

FIG. 87 shows a clip advancer pushes first clip through doors;

FIG. 88 shows a walking beam and clip advancers move forward topartially advance clip over vessel in jaws. The walking beam pusherstays stationary;

FIG. 89 shows the walking beam stops and the clip advancers push theclip the final distance;

FIG. 90 shows punch doors fully closed against punch ring;

FIG. 91 shows once the doors are closed the walking beam advances againand latches the clip;

FIG. 92 shows the walking beam and clip advancers return to their startposition;

FIG. 93 shows a start of clip advance and latch;

FIG. 94 shows a clip pushed through punch doors;

FIG. 95 shows a clip opened by wedges on punch doors;

FIG. 96 shows a clip pushed out of wedge/punch doors;

FIG. 97 shows a clip latched;

FIG. 98 shows a cross section end view with punch doors opened;

FIGS. 99-108 shows a side view of an applier;

FIG. 109 illustrates a side view of the clip according to anotherembodiment

FIG. 110 illustrates a top view of the clip shown in FIG. 109;

FIG. 111 illustrates an isometric view of the clip shown in FIG. 109;

FIG. 112 illustrates an isometric view of a clip engaging a bloodvessel;

FIG. 113 illustrates a side view of a clip engaging a blood vessel.

FIG. 114 is an isometric view of an applier records of in accordancewith an embodiment of the invention;

FIG. 115 is a partial isometric view of a distal end of an applier;

FIG. 116 is a partial isometric view of the jaws on applier engaging ablood vessel;

FIG. 117 is a isometric, partial, exploded view of a distal end of anapplier;

FIG. 118 is a partial cross-sectional view of a midsection of anapplier;

FIGS. 119-126 are isometric, cutaway views of the distal end of anapplier;

FIG. 127 is an isometric view of a clip stick pusher;

FIG. 128 is a side view of a clip stack pusher;

FIGS. 129A and 129B are front and rear views of a clip stick pusher;

FIG. 130 is a partial cutaway distal view of an applier;

FIG. 131 is a partial, perspective view of the distal end of a camfinger assembly;

FIG. 132 is a partial, exploded view of a cam finger assembly;

FIGS. 133-138 are partial cutaway isometric views of the distal end ofan applier;

FIG. 139 is an exploded view of a handle portion of an applier;

FIGS. 140-145 are partial cutaway views of the handle portion of theapplier

FIG. 146 is a side view of another clip that may be used in accordancewith invention;

FIG. 147 is a side view of the clip shown FIG. 146 and a closedposition; and;

FIG. 148 is a isometric view of the clip illustrated in FIG. 146.

DETAILED DESCRIPTION

The invention will now be described with reference to the drawingfigures, in which like parts are referred to with like referencenumerals throughout. Clips that may be used in accordance with someembodiments of the invention are described in U.S. provisional patentapplication No. 61/312,156, filed on Mar. 9, 2010, and U.S.non-provisional application Ser. No. 13/042,864, filed on Mar. 8, 2011by Philip Schmidt, et al. the disclosures of which are both incorporatedby reference in their entirety.

FIG. 1 shows a view of a first embodiment of a surgical ligation clip100 in accordance with present invention. The clip 100 defines alongitudinal axis “L” along its longest dimension and includes a firstleg 101 and a second leg 102 each extending along the longitudinal axisL and having proximal 111, 112 and distal 121, 122 end portions withrespect to said longitudinal axis. As used herein, the term “proximal”shall refer to the portion of the clip referenced herein which is awayfrom the tips of the clip which open, and “distal” shall refer to theportion of the clip at the tips which open, in accordance with theconvention that the clip is inserted distal tip first through aninstrument towards an anatomical body to be ligated, such that distalgenerally refers to the direction away from the user or applier of thesurgical clip and proximal refers to the direction opposite to distal.

In clip 100, a clip hinge 130 joins the first and second legs 101, 102at a point on their respective proximal end portions 111, 112, the firstand second legs each having respective inner clamping surfaces 131, 132between the clip hinge 130 and the distal ends 123, 124 of said firstand second legs, the clamping surfaces being apposed when the clip is ina fully closed position. As used herein, the term “apposed” when usedwith regard to the inner clamping surfaces 131, 132 shall mean close to,or nearly in contact with each other, allowing for some small spacingtherebetween or a concave radius of curvature for the clamping surfaces,such to allow for a clipped vessel to reside between such apposedsurfaces, as is more fully illustrated herein and with respect to thedrawing figures. The clip hinge 130 can include a bar or cylindricallyshaped body or tube which defines a lateral pivot axis “P” (shown inFIGS. 2b and 2c ) about which the legs 101 and 102 pivot as the clipmoves from open to closed position and vice versa. A first jaw structure141 on the first leg 101 extends proximal to a transverse axis “T” whichis perpendicular to both the longitudinal axis L and lateral pivot axisP, all intersecting at a point “X” centered on the clip hinge 130, asshown in FIG. 1. As used throughout herein, the term “lateral” shalldirectionally mean orthogonal to both the directions of the longitudinalaxis L and transverse axis T, and parallel to pivot axis P as shown inthe figures. The first jaw structure 141 includes a first curved innersurface 143 extending from the clip hinge 130, the first curved innersurface 143 having a complex surface which is oriented at changingangles with respect to, but is generally facing towards, thelongitudinal axis L, as shown in FIG. 1. The curved inner surface 143 istherefore substantially concave when viewed from the longitudinal axis(or plane spanning the longitudinal axis and pivot axis). As usedherein, the term “substantially concave” shall mean a surface which isconcave in overall curvature, but which may include one or morecomponent areas which may have convex segments or protrusions, such as anotch surface or recess for mating thereto. A second jaw structure 142is on the second leg 102 extending proximal to the transverse axis T andhas a second curved inner surface 144 extending from the clip hinge 130.As used herein, the “curved inner surface” can include either a singlesmoothly curved surface segment, or a series of connected curved orstraight planar segments, which, taken together, form an overallgenerally curving surface. As described herein, the surgical clip of thepresent invention provides that the jaws 141 and 142 are eachsubstantially proximal to a transverse plane extending throughtransverse axis T and lateral pivot axis P, thus behind the clip hinge130, thereby providing a means for actuating the clip legs 101 and 102and biasing or locking the clip and its mating faces 131, 132 in aclosed position, which biasing or locking means can be actuated and/orapplied by acting only on the proximal end portions of the clip 100,without having to lock the distal ends 123, 124 to each other or use aclip applier tool which acts on said distal ends 123, 124, therebyobviating the need to dissect tissue around the distal end of the clipas in previously known surgical ligation clips.

As shown in FIG. 1, the means for biasing or locking the clip closedincludes a wedge or buttress body 150 which extends from and isconnected to the second jaw structure 142 by a first living hinge 160 ata proximal end of said second jaw structure 142, the buttress body 150having an outer surface 151 at a proximal first end portion thereof,which is also disposed approximately as the proximal end of the clip 100overall. The first and second jaw structures 141, 142 are spaced onopposite sides of the longitudinal axis L and define a locking space 170there between. The wedge or buttress body 150 is pivotable about theliving hinge 160 to move into the locking space 170 such that the outersurface 151 of the proximal first end portion of the buttress body 150abuts against a proximal portion 145 of the curved inner surface 143 ofthe first jaw structure 141 to bias the clip in a closed position (asbest shown in FIGS. 11a , and 12-14). Although the clip 100 is shown inFIG. 1 in a closed position, this is with the locking means of the firstand second jaws 141, 142 and buttress body 150 being in the “unlocked”position as shown in FIGS. 1, 2 a, and 3-7. Once the buttress body is inthe “locked” position as shown in FIGS. 11a and 12-14, the first andsecond jaws 141, 142 are urged or spread apart (shown, as an example, byarrows “J1” and “J2” in FIGS. 13a and 14a ) by action of surfaces of thewedge/buttress body 150 acting on portions of curved inner surfaces 143,144, which act as moments about the clip hinge 130 and lateral pivotaxis P to urge the legs 101, 102 and its inner clamping surfaces 131,132 to become more closely apposed to each other, thereby providingadditional clamping and closing force over a vessel around which theclip is applied.

A variety of means may be used to actuate the wedge or buttress body 150from the unlocked position in FIG. 1 to the locked position shown inFIGS. 11a , 12-14. As shown in FIG. 1, an external force, shown, forexample, as arrow “F” in FIG. 1, may be applied to a proximal end of thepivoting buttress body 150, in this example the external force F beingsubstantially aligned with the longitudinal axis L. Alternatively, theexternal force applied may be at a small angle to the longitudinal axisL, such as, for example, a force shown by arrow “F*” shown in FIG. 1. Ineither case, the applied external force will create a moment aboutliving hinge 160 to pivot the buttress body 150 into the locking space170. The external force may be applied by an actuating rod or otherstructural means in an applier instrument, or may be another clip as fedthrough a multi-clip applier. As one example, the clip 100 may beinserted through an instrument having a bore or channel for receivingthe clip 100, through which the clip 100 may travel distally forpositioning near a vessel during a surgical procedure. The clip may beinserted in a legs closed position, but with the proximal locking meansincluding buttress body 150 in open, unlocked position. Because the clip100 can be inserted in such fashion in closed form, the clip forms anarrow profile and can fit in smaller sized surgical instruments,thereby allowing for smaller incisions and tissue dissection or damageduring surgery. A rod or other actuating mechanism translating ormoveable on the instrument inserting the clip, or a second instrument orsecond clip used in conjunction with the instrument used for insertingand positioning the clip in place, maybe used to lock the clip byapplication of an external force on the proximal end portion of the clipas discussed above.

Thus, a method of applying a surgical ligation clip on a vessel inaccordance with an embodiment of the invention includes positioning aclip, such as, for example, clip 100, in an open position proximate avessel, the clip having first and second legs each extending along alongitudinal axis of the clip and having proximal and distal endportions with respect to said longitudinal axis, a clip hinge meansjoining the first and second legs at a point on their respectiveproximal end portions, the first and second legs each having innerclamping surface means between the clip hinge and the distal endportions of said first and second legs, the clamping surface means beingapposed when the clip is in a fully closed position. A locking means forbiasing the legs closed may extend proximal to a transverse axisperpendicular to the longitudinal axis intersecting at a point centeredon the clip hinge. The method includes applying an external force to aproximal end portion of the clip or of one of the legs which forms aportion of the locking means, to move a body formed as a first part ofsaid locking means from a first position to a second position to providean abutment force between said body and a surface formed on a secondpart of said locking means to bias the clip in a closed position. In themethod, an instrument may be used, wherein, in moving the clip throughthe instrument prior to positioning the clip proximate a vessel, aportion of the instrument opens the clip from a closed position to anopen position, such that the legs of the clip open for placement of theclip around a vessel. The locking means may then be applied to theproximal end portion of the clip to move and bias the legs closed andclamp the clip more fully over the vessel.

In FIG. 1, the clamping surfaces appear substantially parallel to eachother, oriented, in the clip closed position, substantially or veryclose to parallel to a plane extending through the longitudinal axis Land lateral pivot axis P. However, in an embodiment of the invention,the inner clamping surfaces 131, 132 may be slightly curved concave whenfacing said surfaces, such that the surfaces bow away from thelongitudinal axis L and straighten slightly when clamping force isapplied by action of the locking mechanism of the buttress body 150acting against jaws 141, 142. This allows for enhanced grasping andocclusion of vessels around which the clip 100 is applied, wherein theclamping force is spread more evenly across the clamping surface.

The living hinge 160 connecting the wedge or buttress body 150 to thesecond jaw 142 can be integral to the second jaw 142 such that the clipbody of second leg 102 proximal to transverse axis T extends as a singleunitary structure including the second jaw 142 and entire wedge orbuttress body 150. Accordingly, in the wedge or buttress body 150, alateral beam or curved body 152 connects the living hinge 160 to therest of the buttress body 150, which beam 152 curves from the livinghinge 160 (which is separated by a distance from the longitudinal axisL) towards the longitudinal axis L. As shown in FIG. 1 portions of wedgeof buttress body 150 can be oriented on both sides of longitudinal axisL. The pivot axis of living hinge 160 extends in a lateral directionparallel the lateral pivot axis P of the main clip hinge 130.

The present invention provides, in various embodiments, a lockingmechanism cooperating between the buttress body 150 and another portionof the clip. In the clip 100 shown in FIG. 1, the proximal end portion145 of the curved inner surface 143 of the first jaw structure 141defines a notch 147 recessed from said curved inner surface 143, and thebuttress body 150 defines a detent 157 formed on the outer surfacethereof, the detent 157 mating with the notch 147 when the buttress body150 is pivoted into the locking space 170 to bias the clip in the closedposition, as best shown in FIGS. 11a , 12, and 14.

FIGS. 2a, 2b, and 2c show side, top, and bottom views respectively, ofthe clip shown in FIG. 1. As shown in FIG. 2b , the wedge or buttressbody 150 can be divided into two lateral sections or portions 150 a and150 b, each on opposite sides of the longitudinal axis L as shown, andcan form approximate lateral halves of the buttress body 150, with apossible space or small channel in-between. Lateral portion 150 b of thebuttress body 150 can have a width in a plane spanning the transverseand longitudinal axes sufficient to exceed a complementary width formedby the locking space 170 to create an interference fit between theproximal end portion 145 of the curved inner surface 143 of the firstjaw structure 141 and the outer surfaces 151 a, 151 b on the proximalfirst end portion outer surface 151 of the buttress body 150, to biasthe clip in a closed position. An example of the transverse width ofsaid lateral portion 150 b is shown as distance “TW1” in FIG. 7a , withcomplementary width “TW2” being formed by the locking space 170, itbeing understood that TW1 is slightly greater than TW2 in order tocreate the interference fit. In the embodiment as shown in FIGS. 1, 2 b,and 7 a, on lateral portion 150 b there is no detent 157, and saidlateral portion 150 b of the buttress body is formed by a partiallateral width of the buttress body 150. Thus, as shown in FIG. 2b , thenotch 147 and detent 157 are formed on corresponding partial lateralsections or slices of the buttress body 150 and first jaw structure 141,respectively, this lateral section 150 a of buttress body 150 being onthe opposite side thereof to the lateral section 150 b. In this manner,the buttress body 150, once locked into place as shown in FIG. 12, isprevented from moving laterally from side to side since the notch 147and detent 157 interlock only extends laterally partially across theclip, the detent 157 being limited in lateral movement by a shoulder 187formed by a termination of the notch 147 laterally into the first jawstructure 141, as shown in FIG. 9. As shown in FIG. 8b , the lateralslice of buttress body 150 only extends for a lateral width LW1 whichincludes detent 157, which the lateral slice LW2 of buttress body 150 onthe other side of the clip does not include the detent 157. In thismanner, the proximal locking mechanism of the clip 100 is more stable inlateral directions, which is also useful for keeping all parts of theclip together in the event the living hinge 160 may break.

As best shown on FIG. 5, the outer surface 151 on proximal first endportion of buttress body 150 on a proximal end of the clip 100 definesone or more surfaces which form a curved planar segment abutmentportion, which in the embodiment as shown includes curved planar segmentabutment portions 151 a and 151 b. As used herein, the “curved planarsegment abutment portion” formed by a surface may include a singlecurved surface segment or a series of curved or straight planar surfacesegments connected to one another which form an overall generally curvedsurface, each of the surface segments extending as a surface at leastlaterally. In the embodiment shown in FIG. 5, curved planar segmentabutment portion 151 a included planar and curved surface segmentsformed by the notch 157 and extends laterally for about one-half of thelateral width of clip 100, curved planar segment abutment portion 151 bincludes planar and curved surface segments which also extend laterallyfor about one-half of the lateral width of clip 100. Each of the curvedplanar segment abutment portions 151 a and 151 b on outer surface 151forms a substantial abutment surface that pushes against complementarycurved inner surfaces of jaw 141 to provide a stronger and more stablelocking mechanism for clip 100. This is provided, at least in part, bythe relatively larger and wider surface areas, lateral spans, andsegmented surfaces with interlock and abut against each other to provideenhanced holding strength and stability, beyond what has been previouslyknown or practiced in the field of surgical ligation clips.

As best shown in FIG. 6a , the second curved inner surface 144 on thesecond jaw structure 142 forms a first laterally spanning recessedgroove 146 separated from the clip hinge 130 and a first laterallyspanning ball-shaped or rounded protruding surface 148 proximal to saidrecessed groove 146, and a distal second end portion of the buttressbody 150 forms a second laterally spanning recessed groove 158 and asecond laterally spanning ball-shaped or rounded protruding surface 156distal to said second recessed groove which are shaped complementary tothe first rounded surface 148 and first recessed groove 146,respectively, so as to mate in abutment when the buttress body 150 ispivoted into the locking space 170 to further stabilize and bias theclip in a closed position. The first recessed groove 146, first roundedsurface 148, second recessed groove 158, and second rounded surface 156may extend laterally all the way across the lateral width of thebuttress body 150, such that the first rounded surface 148 and secondrounded surface 156 are not spherically shaped but rather form anextended, laterally-spanning, rounded, semi-cylindrical surface whichcan mate in corresponding semi-cylindrical shaped grooves formed byfirst recessed groove 146 and second recessed groove 158.

As shown in FIG. 6a , the buttress body 150 can further define a secondliving hinge 162 extending laterally between the proximal first endportion 150 c of buttress body 150 and a distal second end portion 150d, wherein the proximal first end portion 150 c including outer surface151 further pivots about said second living hinge 162 when the buttressbody 150 moves into the locking space 170, allowing the outer surface151 of the proximal first end portion 150 c of the buttress body to flextowards the longitudinal axis L prior to abutment against the curvedinner surface 143 of the first jaw structure 141.

As best shown in FIGS. 5 and 12, the outer surface of the proximal endof the buttress body 150, or clip 100 itself, defines a V- or L-shapedlaterally spanning notch 150 x on the proximal end of the clip 100 andfurther defines a laterally spanning flange 150 y extending from saidnotch 150 x adjacent to the curved planar segment abutment portions 151a and 151 b. Each of notch 150 x and flange 150 y may be divided intotwo lateral sections or components divided by a small space or channelthere between as they are disposed on the lateral sectional halves 150 aand 150 b of the buttress body 150. The notch 150 x provides a receivingspace for the tip of an instrument, pushing or actuating rod, or anotherclip, so as to enable a more stable actuation of the buttress body 150into locking space 170 to lock the clip 100. The flange 150 y may act tolimit the movement of buttress body 150 once fully inserted into lockedposition inside space 170, and also further stabilizes the lockingmechanism for the clip 100.

In the embodiment shown in FIGS. 1-15, the buttress body may occupy amajority of a volume defined by locking space 170 when it is moved intoclip locked position so as to bias the legs 101, 102 in a closedposition. The volume defined by the locking space is limited by thelateral width of the clip legs 101, 102 near the hinge 130 and the jaws141 and 142. As shown in FIG. 13a , the remaining locking space 170′between jaws 141 and 142, once the clip is locked by movement of thebuttress body 150 into space 170, is less than half the volume of thelocking space 170 as shown in FIG. 6a . The presence of a bulky bodylike buttress body 150 which occupies the majority of the volume orspace between proximal extending jaws 141 and 142 when the clip 100 isin the locked position further provides a greater strength and stabilityto the locking of said clip.

In the embodiment shown in FIGS. 1-15, and as shown in FIG. 6a , thebuttress body 150 can be characterized in one way as having a core masswhich has, in a transverse plane spanning the longitudinal andtransverse axes, a cross-section which approximately spans a trapezoidalshape, having rounded curved sides extending from the sides TP1, TP2,TP3, TP4 of the trapezoid. Side TP1 defines the longest side and one ofthe parallel sides of the trapezoid, while side TP2 defines the shorterparallel side. Side TP3 defines the longer and more distal of thenon-parallel sides, while side TP4 defines the shorter and more proximalnon-parallel side. Side TP1 is therefore connected to sides TP3 and TP4.When the clip is in the unlocked position as shown in FIG. 6a , and thebuttress body 150 is fully extended away from the clip hinge 130 out inthe most proximal position, the vertex TPX1 of sides TP1 and TP4 liesapproximately on or near the longitudinal axis L, and side TP1 makes anangle α below the longitudinal axis, towards proximal jaw 142, suchangle α being, in one embodiment, approximately 30 degrees. As shown inFIG. 6a , the rounded laterally-spanning protuberance 156 extendssubstantially from side TP3.

The clip hinge 130 can also be a resilient hinge providing additionalbiasing force to maintain the inner clamping surfaces 131, 132 of thelegs towards a closed position. A span of each leg extending from theclip hinge 130 to its respective distal tip 123, 124, can be, in oneembodiment of the present invention, at least 75% to 80% of an overalllength of the clip. As shown in FIGS. 2b and 2c , the clip hinge 130 candefine lateral bosses which extend laterally from the side surfaces ofthe clip legs, defining a bossed width or span which is greater than theclip width.

In the embodiment shown in FIGS. 1-15, the clip hinge 130 is formed as alaterally extending bar 130 x integrally formed with the first andsecond legs 101, 102, each leg being resiliently coupled to first andsecond transverse sides of said bar, the bar 130 x further defininglaterally spanning grooves 130 a and 130 b on longitudinally distal andproximal sides of the bar, respectively. These grooves 130 a and 130 bfurther enable the clip 100 to flex as pivoting about the lateral axisof hinge 130, and further provide a resilient pivoting moment or forceabout said hinge.

Furthermore, in the embodiment shown in FIGS. 1-15, flanges 191 and 192extend longitudinally across respective outer surfaces of each of thefirst and second legs 101, 102 which are on opposite sides to the innerclamping surfaces 131, 132 of each respective leg, the flange 191 of thefirst leg 101 extending from the first jaw structure 141 to the distalend portion 121 of the first leg 101, the flange 192 of the second leg102 extending from the second jaw structure 142 to the distal endportion 122 of the second leg 102. Each of the flanges 191, 192 definesa transverse indentation 191 a, 192 a proximate the distal end portions121, 122 of the legs 101, 102. The flanges 191 and 192 provide arigidity to legs 101 and 102, respectively, such that said legs do noteasily bend. Transverse indentations 191 a and 192 a provide a means fora clip applier to better actuate or grip the legs 101, 102.

The clip 100 further includes serrations, ridges, or teeth 181, 182 onthe inner clamping surfaces 131 and 132, respectively, as shown in FIGS.6b and 7b , and 9, 10, and 15 a. The teeth or ridges 181, 182 provideadditional grasping means to better attach and clamp the clip 100 onto avessel when closed. The teeth or ridges 181, 182 are disposed to fitinto complementarily arranged grooves 183 and 184 on the clampingsurfaces 131 and 132, respectively. The teeth 181, 182 may have aslanted orientation, extending proximally, so as to better grip tissue.As best shown in FIGS. 6-6 a and 7-7 a, a pair of distal hook elements194 and 195 may be disposed on the absolute distal tips of legs 101 and102, respectively, each hook 194 and 195 offset laterally with respectto each other to form a scissor-like configuration, such that each hook194 and 195 fit into corresponding recesses 195 a and 194 a,respectively, on the distal tips of legs 102 and 101, respectively. Thismechanism provides means to further grip and contain tissue with thespace between the clamping surfaces 131, 132 when the clip 100 isapplied to body vessel, as illustrated in FIGS. 19 and 20.

The clip 100 may be in a range of sizes. As shown in FIG. 15, an overalllength “S1” of the clip 100 may be approximately 0.50 inches; the length“S2”, between the intersection of transverse axis T and longitudinalaxis L centered at clip hinge 130 and the distal tip of the clip, may beapproximately 0.40 inches, and the radius of curvature of the innermating or clamping surfaces 131, 132 of the legs 101, 102 may beapproximately 3.0 inches. Such sizes and dimensions are given as anexample, and it is understood that the clip may, in one or moreembodiments of the invention, vary in size ranging from approximately0.15 to 0.80 inches in overall longitudinal length, and fromapproximately 0.03 to 0.15 inches in lateral width. As one embodiment ofthe invention, the illustration of clip 100 in FIG. 15 is shown as ascaled magnification of actual size, and shows all the parts of the clip100 in actual proportion to each other.

The instrumentation used to deploy the clips discussed herein mayinclude a manually loaded device that can apply a single clip at a time,or an automatically fed, multi-clip applier. Both appliers can beendoscopic instruments suitable for use in laparoscopic surgeryapplications. In both cases the applier will clamp over the vessel toflatten the section to be ligated. The clip will then be opened,positioned over the vessel and closed. Once closed, a mechanism willengage the locking feature on the proximal end of the clips disclosedherein, to the to maintain the clamping pressure of the clip. A manualapplier will load/apply a single clip at a time. An automatic applierwill be able to load/apply multiple clips before the instrument has tobe removed from the surgical site. The sequence of clip application isas follows:

-   -   1. The clip is presented in the partially closed condition.    -   2. A device, such as a set of applier jaws clamps down on the        vessel or tissue to be ligated or clamped. The applier jaws have        a channel down the center that is just large enough to allow the        clip to fit in the channel.    -   3. The clip is opened by pressing the proximal legs together        lightly.    -   4. The clip is advanced over the vessel or tissue that is        clamped within the jaws of the applier (the clip traveling in        the channel area of the applier jaws).    -   5. Once fully advanced, the proximal legs are released and the        clip springs back to the partially closed condition.    -   6. The proximal locking mechanisms discussed for the clip        embodiments disclosed herein are actuated or pressed, causing        the legs or ‘clamping section’ of the clips to close tightly on        the vessel or tissue.

The various embodiments of the clips disclosed herein therefore canstart in an as-molded state; can be opened further to better encapsulatethe vessel; and can then be closed further (into a 3rd state). Thisprocess of opening and closing the clip can be repeated as needed, priorto locking. When closed and locked, the clip provides an active clampingforce which can also squeeze the vessel, which is beneficial if thevessel necroses and/or shrinks over time.

The various embodiments of the surgical clips of the present inventionare preferably made of one or more polymer materials, such as, byexample, acetyl homopolymer, but could also be made of a variety ofother materials, including one or more metals, or a combination of metaland polymer or plastic. In selecting the material(s) used, theradiopacity of the clip can be “tuned” to a desirable level, or can betuned to be radiopaque.

The various embodiments of surgical clips of the present invention arean improvement over the known polymeric surgical ligation clips, as wellas standard metal clips. Among the resulting advantages of the surgicalclip of the invention as disclosed herein are: the ability to deliver alarger clip through a smaller endoscopic instrument; the ability toplace a clip on a vessel just like a prior art malleable and deformablemetal clip, with no need for added dissection or cleaning around thevessel, but with greater retention force than metal clips, which resultsin a reduced risk of clips slipping off the vessels. The greater cliplocking stability and clip retention force is accomplished by thelocking feature applying an active biasing or clamping force asdiscussed above, versus the passive clamping action created by plasticdeformation of malleable metal clips.

The following several paragraphs provide a brief description of severalembodiments and refer to the FIGS. Later below a more in-depthdescription is provided and refers to not only the FIGS. but alsospecific reference characters.

The litigation clip applier can be split into three main sections fordiscussion. They are the distal end or shaft, the multistagetransmission, and the handle.

One embodiment of the distal portion of the applier is made up of 12parts. Two feeder rails, see FIG. 21, two wedges, see FIG. 22, twoprimary pushers see FIG. 23, two final pushers, see FIG. 24, inner andouter tubes, see FIGS. 25 and 26, and two jaws, see FIG. 31. Whenassembled the inner and outer tubes are concentric and both attach tothe jaws. The outer tube has tabs with holes that the jaws fit into androtate about. The inner tube connects to the jaws in a pocket thatprovides the cam surface to open and close the jaws, see FIGS. 27 and28. The inner tube acts as a push pull link to actuate the jaws, seeFIGS. 19 and 20 for jaw actuation. The two feeder rails are assembled sothat they make pockets to hold the clips, the number of clips to be heldis determined by the ratio of the overall length of the applier and thesize of the clip. The rails are spring loaded together and spread apartwhen the bosses on the clips pass through to the next pocket. Theprimary pushers ride on the sides of the feeder rails, the primarypusher has spring fingers that are spaced equidistant to match thepockets in the feed rail. When advanced they push the entire stack ofclips forward to the next pocket in the feed rails. They also providethe push that allows the second clip to lock the first clip. The finalpushers ride outside of the primary pushers and are what advanced thefirst clip over a vessel in the jaws of the applier. The final pushersalso hold the first clip in place while the wedges retract. The wedgesare just inside the feeder rails and are spring loaded together at theends to open the first clip as it is advanced forward. The wedges alsomove forward into the jaws to cam the legs of the clip closed after ithas fully advanced. The spring load for the wedges is provided by springtabs in the outer tube that push down on the wedges. There is also afalse clip that has two purposes, the first is to lock the last clip andthe second is to pull on the cable that triggers the low clip indicatorand last clip lockout. The false clip is advanced down the distalportion of the applier the same way the stack of clips is advanced. Foractuation of the parts and clip advance/lock, see FIGS. 32-44.

The proximal end of the applier, or applier handle, is made up of manyparts that provide a user interface portion of the applier. Each of thedistal end actuations are accomplished through the use of the proximalhandle. The handle has a two piece outer shell which stages the internalactuating components and provides a bearing surface for a multi stagetransmission to allow 360° continuous rotation of the distal end. Thereis a two piece rotation knob clamped onto the distal portion of themulti stage transmission which is shaped to facilitate the 360°continuous rotation of the distal end, see FIGS. 46-48.

In one embodiment of the handle there are two triggers, both triggersrotate around the same center point, see FIG. 50. The lower triggeractuates the jaws and the upper trigger actuates the clip deliverysequence. The lower trigger is attached to the multistage transmissionthrough two mirrored linkages which have features that allow the triggerto lock down when the jaws are closed. This feature is an over centercam. The linkages also have an inner profile which allows them to drivethe section of the multistage transmission that actuates the jaws whileallowing the 360° continuous rotation. The return stroke of the lowertrigger is accomplished through a return spring attached to a cable thatwraps around the front of the trigger and based on a pin at the proximalside of the handle. There is a interlock on the upper trigger that locksthe upper trigger until the lower trigger is pulled and locked down toensure a clip is not prematurely delivered. The upper trigger isattached to the multistage transmission through a linkage which has andinner profile that drives the section of the multistage transmissionthat actuates the clip delivery mechanisms and also allows the 360°continuous rotation. The return stoke of the upper trigger isaccomplished through a return spring attached to the back side of thetrigger and based on a pin at the proximal side of the handle. For boththe actuation and return strokes there is a one way pawl that limits thedirection of the upper trigger until a full stroke is completed. Thereis also a low clip indication/last clip lockout that is actuated whenthe false clip moves down shaft. As the clips get low the cable pullsoff of the drum. At the end of the cable is a crimped on ball thatstarts to pull on the lockout latch which begins to move the lockoutlever. The top of the lockout lever has an indicator that shows througha window in the handle outer shells indicating low clips in one colorand then indicates no clips left in another. When there are no clipsleft the lockout lever engages the ligate trigger and locks the triggerin place. The jaw trigger still functions see FIG. 50 for triggers andactuating components.

In a second embodiment of the handle, the trigger functions are reversedso that the upper trigger actuates the jaws and the lower triggeractuates the clip delivery mechanisms.

The distal portion of the applier is connected to the handle through themulti stage transmission, see FIGS. 49 and 50. One embodiment of thetransmission is made up of a two piece outer shell which acts as thebearing to allow the rotation of the distal end. Internal to the shellare features that guide the internal components during the actuationsequences of the applier. There are two jaw links that connect to theinner tube of the distal end and provide the grove for the innerfeatures of the lower trigger linkages. The jaw links snap together andride on the internal surface of the transmission shell. The area betweenthe jaw links is open to allow for additional transmission pails. Thereare two center spindles that snap together and attach to the wedges, theouter surfaces provide a guide for the final pusher latch and theprimary pusher latch. The final pusher latch and the primary pusherlatch move over the center spindles and are guided in slots on the outershell of the transmission. Small pins move in and out of groves in thetwo pieces and the outer shell to achieve the appropriate timing for theclip delivery mechanisms in the shaft, see FIGS. 59-66 for thetransmission assembly and FIGS. 67-76 for actuation sequence.

Another embodiment of the distal portion of the applier is made up of 10parts. One outer tube, one inner tube, two jaws, one walking beam, seeFIG. 77-79, one walking beam pusher, see FIGS. 80 and 81, one punchring, see FIG. 82, two punch doors with door wedges, see FIGS. 83 & 84,and two clip advancers, see FIG. 85. When assembled the inner and outertubes are concentric and both attach to the jaws. The outer tube hastabs with holes that the jaws fit into and rotate about. The inner tubeconnects to the jaws in a pocket that provides the cam surface to openand close the jaws. The inner tube acts as a push pull link to actuatethe jaws. When assembled the walking beam pusher rides in grooves on thewalking beam. The punch ring is permanently fixed to the distal end ofthe walking beam and provides the attachment point for the punch doors.The punch doors are attached to the punch ring via a rivet or tabs thatallow the doors to rotate. The doors are forced closed by a torsionspring or may be a plastic part that has spring like characteristicsthat keep the doors closed. On the underside of the punch doors arewedges that force the clip to open when the clip is pushed through thedoors. The clip is pushed forward by a pair of clip advancers that rideon the outside of the walking beam and walking beam pusher. Foractuation of the parts and clip advance/lock, see FIG. 86-97. Across-section of the distal end is shown in FIG. 98 for assemblyreference.

The distal portion of the applier would be attached to a proximal handlewith components that achieve the proper sequence to successfully apply aligation clip. The following discussion refers to the FIGS. and specificreference characters.

FIG. 16 shows an applier 1000 in accordance with an embodiment of theinvention. The applier 1000 is shown about to clamp a blood vessel ortissue 1002. The applier 1000 includes jaws 1004, a shaft 1003, and aclamshell transmission housing 1007. The applier 1000 also includes aclamshell housing 1009, a handle 1011, a ligate trigger 1013, and a jawactuating trigger 1015.

FIGS. 17 and 18 shows a clip 100 after it has clamped a vessel or tissue1002 via the applier 1000. As shown in FIG. 18, the clip 100 has thefirst 101 and second legs 102 locked in a clamping position over thevessel or tissue 1002. The buttress body 150 on the clip 100 has movedforward and locked the legs 101 and 102 by interlocking the detent 157into the notch 147.

FIG. 19 shows the applier 1000 about to clamp a vessel or tissue 1002.The upper jaw 1006 and the lower jaw 1008 are positioned to be above thevessel or tissue 1002. FIG. 20 shows the jaws 1004 of the applier 1000shut and thereby clamping the vessel or tissue 1002 with the jaws 1004.

FIGS. 21-31 show various parts of the applier 1000. FIG. 21 shows a feedrail 1010. The feed rail 1010 has end projections 1014 and cut out slots1012. The cut out slots 1012 form slots that will be discussed in moredetail later. FIG. 22 shows a wedge 1016. While only one is shown inFIG. 22 in the applier 1000, there are two wedges 1016 and they areidentical or mirror images of each other. The wedges 1016 include athicker portion 1018, a slanted surface 1020 and define a U-shapedchannel 1022.

FIG. 23 shows a primary pusher 1024. While only one primary pusher 1024is shown in FIG. 23 there are two primary pusher 1024 that are identicalor mirror images of each other in the applier 1000. The primary pusher1024 includes a flat portion 1026, two rails 1028, and several forkedengagers 1030. The forked engagers 1030 connect to the flat portion 1026via a engager connector 1032. The number of forked engagers 1030 mayvary depending upon the length of the shaft 1003 (See FIG. 16) and howmany clips 100 are loaded in the applier 1000. The forked engagers 1030are used to move the clips 100 forward and will be discussed furtherbelow.

FIG. 24 shows a final pusher 1036. The final pusher 1036 includes apusher backing 1037, two sets of pusher rails 1038, a pusher engagerconnector 1040 and a final pusher forked engager 1042. The final pusherforked engager 1042 will engage and push a clip 100 (not shown in FIG.24) as will be discussed later.

FIG. 25 shows an inner tube 1044. The inner tube 1044 has T-shapedconnecting structure 1046, U-shaped channels 1048, a top slot 1050 andguides 1052 in the top slot 1050. FIG. 26 shows a outer tube 1054. Theouter tube 1054 provides the outer housing for the shaft 1003. The outertube 1054 has eye brackets 1056 defining holes 1058. The outer tube 1054also has leaf spring limbs 1060. The leaf spring limbs 1060 extend intothe interior of the outer tube 1054.

FIG. 27 shows the jaws 1004 connected to the inner tube 1044. The jaws1004 have T-shaped structure holes 1064. The T-shaped connectingstructure 1046 of the inner tube 1044 fit into the T-shaped structureholes 1064 of the jaws 1004 and allow the jaws 1004 to pivot on theT-shaped structure 1046. The jaws 1004 have jaw grooves 1062 forassisting in the engagement of the jaws 1004 with a vessel or tissue1002. The jaws 1004 also have pushing surfaces 1072. When an objectpushes against the pushing surfaces 1072 the jaws 1004 will pivot on theT-shaped structure 1046 to an opened position. FIG. 28 is an enlargedpartial view of the jaws 1004 and the inner tube 1044. The top jaw 1006has a press point 1070 with the lower jaw 1008. The cam surface 1066 onthe inner tube 1044 is seen as well as the cam surface 1068 on the jaw1006. When an object presses on the press surface 1072 the cam surfaces1066 and 1068 urge against each other as the jaws 1004 open. The camsurfaces 1066 and 1068 also urge against each other as the jaws 1004close.

FIG. 29-31 show various views of the top jaw 1006. The top jaw 1006 isthe same as or a mirror image of the low jaw 1008. The top jaw 1006 hasT-shaped structure holes 1064, jaw hinge pins 1074 and hinge pin caps1076. The hinge pin caps 1076 have been removed from one of the jawhinge pins 1074 for clarity, usually there are hinge pin caps 1076 oneach hinge pin 1074. The top 1078 and the bottom 1080 of the top jaw1006 are shown.

FIG. 32 is a side isometric view of a part of the applier 1000. Theinner 1044 and outer tubes 1054 are cut away to better show interiorparts. The jaws 1004 are clamped on a vessel or tissue 1002. The clip100 has not yet moved forward into the jaws 1004 so that it can clampthe vessel or tissue 1002. The end projections 1014 of the feed rail1010 are visible. The slot cut outs 1012 make a space for the jaw hingepin 1074 to reside. In the position shown in FIG. 32 the final pusherforked engager 1042 is spaced from the hinge pin 1074 on the clip 100.The final pusher engager connector 1040 connects the final pusher forkedengager 1042 to the final pusher back 1037. The clip 100 is in asomewhat open position and the leaf spring limbs 1060 are not engagingthe clip 100. The wedges 1016 can also be seen.

FIG. 33 is similar to FIG. 32 but shows the top feed rail 1010 cut away.The clip 100 and the top wedge 1016 can be seen along with the finalpusher 1036. In FIG. 34, a similar view of the applier 1000 is shown butthe top of the final pusher 1036 is cut away. The clip 100 can be seen.A second clip 1252 can be seen in position behind the first clip 100.The primary pusher 1024 can be seen. Once the first clip 100 is applied,the second clip 1084 will move forward and become the first clip 100(from the point of view of position) as will be explained later.

FIGS. 35-44 will illustrate in cross section views the applicationsequence and forward movement of the clips 100, 1084 in the applier1000. The jaws 1004 are clamped on the vessel or tissue 1002. The endprojections 1014 are visible forward the clip 100. The top wedge 1016 isalso visible. The final pusher 1036 is cut in half for clarity. A secondclip 1084 may also be seen with the primary pusher 1024 behind thesecond clip 1084. FIG. 35 shows an initial condition of the variousparts of the applier 1000 when the jaws 1004 are first clamped on thevessel or tissue 1002.

FIG. 36 shows the start of ligation. The wedges 1016, the primarypushers 1024 and the final pusher 1036 begin to move. The feeder rails1010 spread apart to allow the boss 1082 on the clip 100 to passthrough. The primary pusher 1024 engages the second clip 1084. In FIG.37, the wedges 1016 open the clip 100 and by a camming action betweenthe thicker portion 1018 of the wedge and the clip 100. The final pusher1036 advances the open clip 100 into the jaws 1004 and over the vesselor tissue 1002. The primary pusher 1024 advances the second clip 1084(and any other clips that may be located behind the initial clip 100).FIG. 38 shows the wedges 1084 advancing by action of the primary pusher1024. The wedges 1016 advance to close the clip 100 onto the vessel ortissue 1002.

As shown in FIG. 39 the second clip 1084 advances by action of theprimary pusher 1024 into buttress 150 of the first clip 100 (sometimesreferred to as the initial clip 100). The buttress 150 is moved by thesecond clip 1084 to the point that the detent 157 fits into the notch147 thereby locking the first clip 100 onto the vessel or tissue 1002.In FIG. 40, the wedges 1016 retract, however, the feeder rails 1010(partially cut away in FIG. 40 and are better shown in FIG. 35) staytogether and thus keep the second clip 1084 from retracting. The finalpusher 1036 stays in place to keep the initial clip 100 in a forwardposition. In FIG. 41 the wedges 1016, the primary pusher 1024 and thesecond clip 1084 (and any other clips behind the initial clip retract).

As shown in FIG. 42 the second clip 1084 stops in the slot 1012 (bestshown in FIG. 32) in the feeder rails 1010. The wedges 1016, primarypushers 1024 and the final pusher 1036 begin to retract. FIG. 43 showsthe parts returning to an initial or start condition. The thickerportion 1018 of the wedges 1016 open top 101 and bottom 102 legs of thesecond clip 1084. The first clip 100 was released and exited the applier1000 when the jaws 1004 were opened. The second clip 1084 now becomesthe first clip 100 and the cycle starts over.

FIG. 44 shows how that final clip 1086 is applied. The cycle issubstantially the same as described above for applying a clip 100 but afalse clip 1088 performs the function of locking the last clip 1086.FIG. 45 shows the false clip 1088. The false clip 1088 includeslongitudinal ridges 1090, a butting face 1092, a boss 1094. Thesefeatures perform similar functions as the similar features found on theactual clip 100. The false clip 1088 also has a hole 1096.

FIGS. 46-58 show and describe how the applier receives inputs from auser and provides those inputs to the transmission 1098. Thetransmission 1098 receives the inputs and converts them to motions tothe parts that act on the clips 100, 1084, 1086. FIGS. 46 and 47 show apart of an applier 1000 having a shaft 1003, a transmission housing1007, a clam shell housing 1009, and handle 1011, a ligate trigger 1013and a jaw trigger 1015. While claim shell housings may be describedherein, other types of housings may be used.

FIG. 48 shows and exploded view of part of the applier and some of theinternal mechanisms. The clamshell housings 1009, the handle 1011, thetransmission housing 1007, the shaft 1003 and the transmission 1098 aswell as other parts that will be described in more detail can be seen.FIGS. 49 and 50 shows many of the internal components in more detail.The transmission 1098 has a jaw link input 1110 having a jaw link inputgroove 1112, a center spindle 1114 and a second input 1116 having asecond input groove 1118. An upper grasper lever pin 1102 fits into thejaw link input groove 1112 and moves to provide an input to thetransmission 1098. The upper grasper lever pin 1102 also fits intograsper lever holes 1106 and is controlled by the grasper levers 1100.The grasper levers 1100 have grasper lever slots 1108 in which the lowergrasper lever pin 1104 rides. In some embodiments of the invention, thelower grasper lever pin 1104 fits into the jaw trigger pin holes 1154 onthe jaw trigger 1015. The grasper levers 1100 and thus the input 1110 iscontrolled by the grasper/jaw trigger 1015.

The ligate lever 1120 has ligate lever slots 1122 in which the ratchetplate pin 1160 resides. The ratchet plate pin 1160 also fits in theratchet plate pin holes 1162 on the ratchet plates 1158. Thus, theligate lever 1120 is controlled by the ratchet plates 1158. The ligatelever 1120 has ligate lever trunnions 1124 which fit into the secondinput groove 1118 in the second input 1116. Thus, the ligate lever 1120controls the second input 1116. The ratchet plates 1158 have ratchetteeth 1166 and disengaging cams 1168 that interact with forward 1126 andrearward 1128 facing pawls. The pawls 1126, 1128 ride on a pawl shaft1130 that is connected by a pawl spring 1132 connected to a springanchor 1134. It is noted that the inputs 1110 and 1116 are circular andthe features (i.e. pins) that control the inputs may be rotated 360°about the inputs 1110 and 1116 so that a user can manipulate thetriggers 1013 and 1015 from a rotated position with respect to thetransmission 1098 and jaws 1004. FIGS. 51-58 show the pawl mechanism andits accompanying discussion will explain how the pawl mechanism works.

Springs 1146 and 1148 are used to bias the triggers 1013 and 1015 to aposition against the handle 1011. The triggers 1013 and 1015 and theratchet plates 1158 all pivot about the same hole 1156. A pivot pin maybe provided or trunnion on the housing 1009 may provide a pivot. In someembodiments, a spring extension 1150 may be used to connect either orboth of the springs 1148 and 1146 to a desired feature. In someembodiments the spring extension 1150 may attach to the pin 1152 whichmay fit in holes 1164 in the ratchet plates 1158. A low clip indicatorspring 1136 may fit around a low clip indictor anchor 1138. The low clipindicator 1136 is connected to the low clip indicator 1140, which inturn is connected to the last clip lock out 1142 and grommets 1144. Thelow clip indicator 1140 may help a user to know that the amount of clipsin the applier are low. The last clip lockout 1142 may prevent the userfrom using the applier 1000 when there are no more clips in the applier1000. FIG. 50 shows a trigger lock 1170. The trigger lock 1170 has atrigger lock groove 1172. A trigger release 1178 has a detent 1174 thatfits into the trigger lock groove 1172. A trigger lock spring 1176 urgesthe trigger release 1178 toward the trigger 1013.

FIG. 51 shows an initial condition where the triggers 1013 and 1015 (notwell shown in FIG. 51) are in a position against the handle 1011 (seeFIG. 16) The triggers 1013 and 1015 and the ratchet plates 1158 willmove as shown and described. The teeth 1166 on ratchet plates 1158 arenot engaged with either the forward facing 1126 or the rearward facing1128 pawl. The pawl anchor is attached to the housing 1009 (a fronthousing piece has been removed to the pawl mechanism may be seen). Thedisengaging cam 1168 has disengaged the reward facing pawl 1128 from theteeth 1166. FIG. 52 shows that the rearward facing pawl 1128 isdisengaged with the teeth 1166 and the forward facing pawl 1126 isengaged with the teeth 1166 during the pull of the ligate trigger 1013.In FIG. 53, the forward facing pawl 1126 is engaged with the teeth 1166the rearward facing pawl 1128 is engaged. In FIG. 54 the disengaging cam1168 disengages the pawl 1126 and engages the pawl 1128 with the teeth1166. FIG. 55 shows the pawl 1126 disengaged by the disengaging cam 1168and the cam 1168 engaged. FIG. 56 shows that during the return of thetrigger, the rearward facing pawl 1128 stays engaged with the teeth 1166while the forward facing cam 1126 remains disengaged with the teeth 1166on the ratchet plates 1158. FIG. 57 is similar to FIG. 51 as thetriggers 1013 and 1015 return to the initial position proximate to thehandle 1011. FIG. 58 is a side view of the pawl 1126 and ratchet plate1158 in the position shown in FIGS. 51 and 57.

FIGS. 59-66 show the parts and the layout of the parts of thetransmission 1098 various parts will be removed from the FIGS. to showinterior parts. FIG. 59 is an exploded view of the transmission 1098.FIG. 59 shows the outer rotating housing 1180, 1182 of the transmission.The outer rotating housing 1180, 1182 may be a clamshell housing. Jawlink actuators 1184 and 1186 define the jaw link input 1110 and jaw linkinput groove 1112. The jaw link actuators 1184 and 1186 have attachingstructure 1188 for attaching to parts that will be described later.Within the jaw link actuators 1184, 1186, are final pusher latches 1190,1192. The final pusher latches 1190, 1192 also have attaching structure1194 for attaching to other parts as will be described later.

A primary pusher latch 1202 (or latches, many of the parts may bereferred to in the singular or plural form as many are made of twopieces. However multiple piece are not required to be referred to in theplural form) may have attaching structure 1200 for attaching to otherparts as will be described later. The primary pusher latch 1202 mayinclude attaching pin grooves 1198 for attaching pins 1196. The centerspindle 1114 is attached to the second input 1116 which defines thesecond input groove 1118. The center spindle 1114 has pin grooves 1218.

FIG. 60 shows the transmission 1098 with the outer rotation housing 1180in place and the center spindle 1114 extending from the housing 1182. InFIG. 61, one of the housing members 1182 has been removed. The housing1180 is still present. The jaw link actuators 1184, 1186 are visible.FIG. 62 shows the transmission 1098 with the jaw link actuators 1184,1186 removed. The final pusher latches 1190, 1192 and the primary pusherlatches 1202 are visible along with the attaching pins 1196. FIG. 63 hasthe housing 1180 removed. The final pusher latches 1190, 1192 and theprimary pusher latches 1202 are visible along with the attaching pins1196 in the attaching pin grooves 1198. FIG. 64 shows the transmission1098 with the final pusher latches 1202 and pins 1196 removed. Theprimary pusher latch 1202 is visible. In the transmission 1098 shown inFIG. 65 the final pusher latch 1202 is removed.

FIG. 66 shows the transmission 1098 with the center spindle 1114removed. The wedges 1016 are shown with wedge connection brackets 1204where the wedges 1016 connect to the transmission 1098 via the centerspindle 1114. The connection point 1206 where the primary pusher 1024connects to the transmission 1098. The connection points 1208, 1210, and1212 are shown for connecting the transmission 1098 to the final pusher1036, the inner tube 1044, and the feed rail 1010 respectively areshown. The outer tube 1054 can also be shown. The connections betweenthe transmission 1098 and the various elements are not limited to whatis shown. Any suitable means may be used. One of ordinary skill in theart may, after reviewing this disclosure, conceive of various ways toconnect these features to the transmission 1098.

FIGS. 67-76 are cross sectional views of the transmission 1098 atvarious positions. The movement of the transmission components willcause the components they are connected to move the clip 100 (not shownin these FIGS.) to various positions and/or orientations within theapplier 1000. The components the transmission is manipulating aregenerally not shown in FIGS. 67-76 but they are shown and described withrespect to other FIGS. At FIG. 67, transmission 1098 is in a position tocause the jaws 1004 to be in an open position. The second input 1116 isextended away from the transmission 1098. The jaw link input 1110 isspaced away from the outer housing 1180 of the transmission 1098. Thefinal pusher latch 1190 and the primary pusher latch 1202 may be seen.At FIG. 68 the jaw link input 1110 has moved toward, and contacts thehousing 1180. The jaws 1004 are in a clamped position. The centerspindle 1114 and second input 1116 are still extended. In FIG. 69 theclip 100 is starting to advance. The second input 1116 is moved slightlytoward the jaw link input 1110.

In FIG. 70, the first clip 100 is advanced to be over the vessel ortissue 1002 by the final pushers 1036 and the wedges 1016 advance. Thesecond clip(s) 1084 are advanced by the primary pushers 1024. The finalpusher latch 1190 has moved such that the attaching pins 1196 arealigned with pin notches 1214 in the outer housing 1180. The attachingpins 1196 can move out of the pin grooves 1218 in the center spindle1114 (see FIG. 59) and into the into the pin notches 1214 and thusunlock the final pusher latch 1190 with the center spindle 1114.Likewise, the primary pusher latch 1202 has moved so that the attachingpins 1196 are aligned with the pin slot 1216 in the outer housing 1180.As a result, the pins 1196 can move out of the pin grooves 1218 in thecenter spindle 1114 and into the pin slot 1216 and thus unlock theprimary pusher latch 1202 from the center spindle 1114. The primarypusher latch may move along the center spindle the length of the pinslot 1216.

In FIG. 71 the transmission 1098 is shown where the wedges advance toclose the first clip 100. The second input 1116 moves inward causing thecenter spindle 1114 to move inward. The pins 1196 are moved to the pinnotches 1214 and pin slots 1216 in the housing 1180. In FIG. 72, theclip 100 is latched. The primary pushers 1036 advance the second clip1084 (or false clip 1088) to lock the first clip 100. This isaccomplished by moving the second input 1116/center spindle 1114 furtherinto the transmission 1098. The pins 1196 stay in the pin notches 1214and pin slot 1216. In FIG. 73 the transmission 1098 is shown where thewedges 1016 begin to retract. The center spindle 114 moves out of thetransmission 1098. The pins 1196 are still in the pin notches 1214 andpin slots 1216. The final pusher latch 1190 and the primary pusher latch1202 are unchanged from FIG. 72. In FIG. 74, the center spindle 1114continues to move out of the transmission 1098. The pins 1196 still inthe pin notches 1214 and slots 1216. The final pusher latch 1190 isunchanged from FIG. 72, but the primary pusher latch 1202 has movedback.

In FIG. 75 the position of the transmission 1098 is shown where thefinal pusher 1036 retracts and other parts also retract. The pins 1196are once again aligned with the pin grooves 1218 and the final pusherlatch 1190 and the primary pusher latch 1202 have moved back taking thepins 1196 out of alignment with the pin notches 1214 and pin slot 1216.

FIG. 76 shows the transmission 1098 back in the start position. Thefinal pusher latch 1190 and the primary pusher latch 1202 are move backand the center spindle 1114 is full extracted. The transmission 1098shown in FIG. 76 is similar to the transmission 1098 shown in FIG. 67.

A second embodiment is shown in FIGS. 77-98 this embodiment is similarto the applier 1000 described above, but it uses a slightly differentsystem to move the clips 100, 1084 along. Where the description of thesecond embodiment is silent, as to specific parts, the second embodimentmay be assumed to be similar to the first embodiment with respect to thenot described features.

FIGS. 77-85 show individual elements. How these elements fit togetherand operate are shown and described with respect to FIGS. 86-98. FIGS.77-79 show a walking beam 1220. The walking beam 1220 includes pusherarms 1222 mounted to a side 1224 of the walking beam 1220. The walkingbeam 1220 also has brackets 1226 mounted to one side. FIGS. 80-81 show awalking beam pusher 1228 which includes pusher arms 1230.

FIG. 82 shows a punch ring 1231. The punch ring 1231 includes U-shapedprotrusions 1232 and connecting holes 1234. FIG. 83, shows a punch door1236 that mounts to the punch ring 1231. The punch door 1236 includeseye brackets 1238, holes 1240 in the eye brackets 1238 and slots 1242.FIG. 84 shows a door wedge 1244. FIG. 85 shows a clip advancer 1246having a pushing member 1248.

FIG. 86 shows the elements of the second embodiment fit in an outer tube1054. The position of the element is an initial or start position. Thejaws 1004 are fit onto the outer tube in a similar manner as describedwith respect to the first embodiment. Door pins 1250 are shownconnecting the punch doors 1236 with the punch ring 1231. A clip 100 isshown behind the punch doors 1236.

FIG. 87 shows the clip advancer 1246 pushing the first clip 100 throughthe punch ring 1231 and punch doors 1236. The clip opens by virtue of acamming action between the wedges 1244 and the clip 100 passing by thewedges 1244. FIG. 88 shows the walking beam 1220 and clip advancers 1246moving forward toward the jaws 1004 to partially advance the clip 100over the vessel or tissue 1002 (not shown in FIG. 87.). In FIG. 89 thewalking beam 1229 has stopped. The clip advancers 1246 push the clip 100the final distance into the jaws 1004. The clip 100 is pushed throughthe punch doors 1236 and wedges 1244. The punch doors 1236 closed asthey are spring loaded to do so. In FIG. 90, the clip 100 is fully inthe jaws 1004 and the punch doors 1236 are closed behind the clip 100.In FIG. 91, the walking beam 1220 advances to lock the clip 100. Thewalking beam 1220 has moved forward and presses the punch doors 1236against the buttress body 150 of the clip 100 causing the detent 157 tofit and lock into the notch 147. In FIG. 92, the walking beam 1220, theclip advancers 1246 have returned to the start positions. The secondclip 1084 and any other clips have advanced one position by thestationary walking beam pusher 1228. The clip 100 may be released whenthe jaws 1004 are opened.

FIGS. 93-97 illustrate the process described above but with some of thecomponents removed for clarity. In FIG. 93, clip 100 starts to advanceby the pusher arm 1230 of the walking beam pusher 1228 pushing againstthe second clip 1084. The brackets 1226 on the walking beam 1220 areshown. The brackets 1226 allow the walking beam pusher 1228 to slidablyconnect to the walking beam 1220. The punch ring 1231 is visible and thepunch doors 1236 are shown on the punch ring 1231. In some embodimentsof the invention, the punch doors 1236 connect to the punch ring 1231 byhinge pins 1250 in the holes 1234 in the punch ring 1231 and holes 1240in the eye brackets 1238 on the punch doors 1236.

FIG. 94 shows the clip 100 partially extending through the punch doors1236. The pusher arm 1230 of the walking beam pusher 1228 is advancingthe clip 100. In FIG. 95 the clip 100 is opened by the wedges 1244 asthe clip 100 passes through the doors 1236. The pusher arm 1230 passesthough the U-shaped protrusion 1232 of the punch ring 1231. In FIG. 96The clip 100 has extended through the punch doors 1236. The pusher arm1230 passes though the U-shaped protrusion 1232 of the punch ring 1231.In FIG. 97 the walking beam 1220 moves forward, but the walking beampusher 1228 remains stationary. The forward movement of the walking beam1220 causes the punch doors 1236 to press against the buttress body 150and rotate the buttress body 150 to lock as the detent 157 interlockswith the notch 147. Thus, the clip 100 is locked in the closed position.

FIG. 98 is an end view of the applier 1000 where the punch doors 1236are opened. The outer tube 1054 may be seen. The door wedges 1244 areshown in the punch ring 1231. The U-shaped protrusions 1232 are alsovisible. The brackets 1226 on the walking beam 1220 holding the walkingbeam pusher 1228 are also visible.

FIGS. 99-108 show various trigger 1013 and 1015 positions that may occurwhile the applier 1000 is performing various steps.

In another embodiment, a different clip 2000 and adapter 2040 is used.This clip 2000 and adapter 2040 is shown and described in FIGS. 109-113.FIG. 109 shows a side view of the clip 2000. The clip 2000 includes anupper leg 2002 and a lower leg 2004. Both legs 2002 and 2004 includeteeth 2006 and grooves 2007. The upper leg 2002 includes an upper frontend 2008 the lower leg 2004 includes a lower front end 2010. The upperfront end 2008 includes an upper slanted edge 2012 and the lower frontend 2010 includes a lower slanted edge 2014. The upper leg 2002 and thelower leg 2004 pivot about a hinge portion 2016 which is part of a bodyportion 2018.

The body portion 2018 includes a locking void 2020. The clip 2000 islocked by moving a buttress 2022 into the locking void 2020. Thebuttress 2022 includes a buttress void 2024. The body portion 2018includes locking wings 2026. The locking wings 2026 help retain thebuttress 2022 into the locking void 2020 when the clip 2000 is in alocking position. The buttress void 2024 includes locking interiorsurfaces 2030. The buttress 2022 includes locking exterior surfaces2032. When the buttress 2022 is in the buttress void 2024, the lockinginterior surfaces 2030 and the locking exterior surfaces 2032 will be incontact with each other.

The buttress 2022 is attached to the body portion 2018 and theconnectors 2034. The connectors 2034 are resilient and will flex topermit the movement of the buttress 2022 with respect to the bodyportion 2018. The connectors 2034 are equipped with projections 2036.The projections 2036 are useful when the clips 2000 are arranged in anautomatic applier in a nose to tail fashion. In such an instance, theupper front end 2008 and lower front end 2010 of a clip 2000 behind afirst clip 2000 will engage the projections 2036 of the clip 2000 infront.

FIG. 110 illustrates a top view of the clip 2000. The upper leg 2002 andthe upper front end 2008 are visible. The connector 2034 connecting thebuttress 2022 and having the projection 2036 is also shown in FIG. 110.

FIG. 111 illustrates an isometric view of the clip 2000. The upper leg2002, the lower leg 2004, the grooves 2007, and teeth 2006 are visible.The lower slanted edge 2014 can also be seen. The hinge portion 2016,the buttress void 2024, and the buttress 2022 are also visible in theisometric view shown in FIG. 111.

FIGS. 112 and 113 illustrate the clip 2000 clamping onto a vessel 2038.The grooves and teeth are not shown and are removed for clarity in FIGS.112 and 113. The vessel 2038 is clamped between the upper leg 2002 andthe lower leg 2004. The buttress 2022 has been moved into the buttressavoid 2024 causing the locking interior surfaces 2030 and a lockingexterior surfaces 2032 to be in contact with each other. Movement of thebuttress 2022 into the buttress avoid 2024 has caused the upper leg 2002and the lower leg 2004 to be locked in a closed position. It will beappreciated that closing of the clip 2000 will cause the hinge portion2016 to rotate thereby enlarging the buttress avoid 2024 and allowingthe buttress 2022 to be pushed or moved into the buttress void 2024thereby locking the clip 2000 in the closed position. Once the clip 2000is in the closed position the vessel 2028 is clamped.

FIG. 114 illustrates an automatic applier 2040. The automatic applier2040 includes jaws 2042. The jaws 2042 including upper jaw 2044 and alower jaw 2046 an outer tube assembly 2048 is located between the jaws2042 and a handle assembly 2050. The handle assembly 2050 includes ahandle 2052 and actuator 2054. The actuator 2054 functions and actssimilar to a trigger and is pivotally connected to the handle assembly2050. The handle assembly 2050 also includes a body 2056 and a rotator2058. The rotator 2058 is configured to allow a user to rotate therotator 2058 which will thereby rotate the outer tube assembly 2048 andthe jaws 2042. Therefore the jaws 2042 can be oriented or rotated 360°to any orientation desired by a user. The automatic applier 2040includes a distal end 2060 which includes the jaws 2042 and a proximalend 2061 which includes the handle assembly 2050.

FIG. 115 illustrates a portion of the distal end 2060. The outer tubeassembly 2048 includes bosses 2062. The bosses 2062 define holes 2064.Jaw projections 2066 extend from the jaws 2044 and 2046 outwardlythrough the holes 2064. The jaws 2044 and 2046 pivot about the jawprojections 2066 which pivotally connected jaws 2044 and 2046 to theouter tube assembly 2048. The jaws 2042 are shown in an open conditionand contain a clip 2000. The jaws 2042 have approached flesh or a bloodvessel 2038 but have not yet contacted it.

FIG. 116 illustrates the distal end 2060 and shows the jaws 2042, 2044,2046 clamped on the flesh or vessel 2038. A portion of the clip 2000 canbe seen within the jaws 2042. Closing the jaws 2042 is caused the clip2000 to also be closed.

FIG. 117 is an exploded isometric view of the distal end 2060. The outertube assembly 2048 is shown along with the top jaw 2044 and lower jaw2046. Both of the jaws 2042 are identical parts and some embodiments ofthe invention. In other embodiments they can be slightly different ormirror images of each other. Each jaw 2044 and 2046 includes a jawprojection 2066 that extends outward and away from the jaws 2044 and2046. The jaw projections 2066 extend into the holes 2064 defined by thebosses 2062 and the outer tube assembly 2048. The jaws 2044 and 2046also include a jaw arm 2068. The jaw arm 2068 defines an inwardprojecting a projection 2070. It is the inward pointing projection 2070that fits within the actuation slots 2082 found on the feed tube 2076.By moving the feed tube 2076 in a distal or proximal direction, theinward projections 2070 on the jaws 2046 and 2044 pivot and cam withinthe slots 2082 to open and close the jaws 2042.

The feed tube 2076 further contain slots 2078 and spring fingers 2080fit within the slots 2078. The spring fingers 2080 are useful inpreventing clips 2000 (not shown in FIG. 117) from moving in a proximaldirection at undesired times. The feed tube 2076 stores a stack of clips2000 which will be discussed further below. The clip lock arm 2072includes a clip engaging portion 2074. The clip engaging portion 2074fits through one of the slots 2078 in the feed tube 2076. The clipengaging portion 2074 is configured to move axially so that the clipengaging portion 2074 will engage and lock a clip 2000 as will bediscussed further below.

A clip advance arm 2084 is equipped with pinchers 2086. The clip advancearm 2084 also is configured to move axially and performs severalfunctions. For example, it moves a clip 2000 forward into the jaws 2042and also opens and closes the clip 2000 by action of the pinchers 2086acting upon either the legs 2002, 2004 (to close the clip 2000) or onthe locking wings 2026 and/or connectors 2034 to open the clip 2000.When assembled, the feed tube 2076, the clip locked arm 2072, and theclip advance arm 2084 are all fit with in the outer tube assembly 2048.

FIG. 118 is a partial cutaway view of the outer tube assembly 2048 andfeed tube 2076 containing a stack of clips 2000. Each clip 2000 has itsupper and lower legs 2002, 2004 pushing on the projections 2036 of theclip 2000 in front of it. A clip stack pusher 2088 pushes on theprojections 2036 of the last clip 2000 of the clip stack. This clipstack pusher 2088 is spring-loaded and has a clip advance rod 2090surrounded by a spring 2092. The spring 2092 urges the clip stack pusher2088 in a distal direction thus urging the clips 2000 also in a distaldirection. Spring 2092 may urge against an internal portion of thehandle assembly 2050 as can be appreciated by one of ordinary skill theart after viewing this disclosure.

FIG. 119 shows the distal portion 2060 including the upper jaw 2044 andthe lower jaw 2046. The jaws 2044 and 2046 are open and about to closeover a tissue or blood vessel 2038. A clip 2000 is shown to be in thejaws 2044 and 2046 and is also in the open position. The pinchers 2086of the clip advance arm 2084 have moved forward and are contacting thelocking wings 2026 and connectors 2034 of the clip 2000. The pinchingpressure placed on the connectors 2034 biases the jaws 2044 and 2046 tobe open. The outer tube assembly 2048 is partially cutaway to exposeinternal components. The clips 2000 contained within the outer tubeassembly 2048 are also shown.

In FIG. 120 the distal portion 2060 is illustrated again in a cutawayview. The jaws 2044 and 2046 are now in a closed position clamping thetissue or blood vessel 2038. In order for the jaws 2044 and 2046 toclose, the feed tube 2076 has moved to a proximate position. However thefeed tube 2076 is not shown in FIG. 120. The clip 2000 and is also inthe clamp position and the connectors 2034 of the clamp are flexing thepinchers 2086 of the clip advance arm 2084. The flex marks 2096 on thepinchers 2086 illustrates this. The broken line region 2094 of thepinchers 2086 also illustrates the interference between the clip 2000and the pinchers 2086. As a result of this interference, the clip 2000and the pinchers 2086 will flex.

FIG. 121 shows the advance arm 2084 moving back to a proximal positionto engage a second clip 2000. Again, the broken line region 2094represents the interference fit between the clip 2000 and the pinchers2086 of the clip advance arm 2084. Both the clip 2000 and the pinchers2086 will flex to accommodate the interference. The second clip 2000 isprevented from moving back in a proximal direction by the rearwardmovement of the pinchers 2086 by the spring fingers 2080 (best shown inFIG. 117) on the feed tube 2076. The clip locked arm 2072 starts toadvance toward the clip 2000 in the jaws 2042. The clip 2000 and thejaws 2042 are clamped onto the vessel 2038, however the clip 2000 is notyet locked in the clamping or closed position.

FIG. 122 illustrates the distal end 2060 cutaway view. The clip advancearm 2084 has moved fully back or in the full proximal position and isnow pinching the connectors 2034 and/or locking wings 2026 therebyurging the clip 2002 to move to an open position. Broken line region2094 on the pinchers 2086 illustrates interference fit between thepinchers 2086 and the clip 2000 and the flex portion 2096 of thepinchers 2086 also illustrates stress on the pinchers 2086 to open. Thusthe pinchers 2086 and the clip 2000 will flex to accommodate thisinterference fit. The clip lock arm 2072 has moved distally forward andhas engaged and moved the buttress 2022 to push the buttress 2022 intothe locking void 2020 to lock the clip 2000 onto the vessel 2038.

FIG. 123 illustrates the distal portion 2060 in a cutaway view. The feedtube 2076 pushes forward or distally thereby opening the jaws 2042,2044, 2046 to release the locked clip 2000 and vessel 2038. The cliplock arm 2072 returns to its initial position. The clip advance arm 2084remains in its pulled back or proximal position. The pinchers 2086 andthe locking wings 2026 of the second clip 2000 are in an interferencefit as indicated by the broken line section 2094. Thus the clip 20 andthe pinchers 2086 will flex to accommodate this fit. The buttress 2022is still in the locking void 2020 causing the clip 2000 now exiting thejaws 2042 to remain locked on the vessel 2038.

FIG. 124 illustrates the distal portion 2060 in a cutaway view. The clip2000 and vessel 2038 are now clear of the jaws 2042 and are thereforenot shown in FIG. 124. The clip advance arm 2084 now pushes the nextclip 2000 distally or forward into the jaws 2042. The jaw projection2066 of jaw 2046 is shown, as well as part of the feed tube 2076 and theactuation slots 2082 containing the actuation projection 2070 attachedto jaw 2044.

FIG. 125 illustrates the distal portion 2060 in a cutaway view. The clipadvance arm 2084 moves forward or distally to push the clip 2000 intothe jaws 2042. At the same time, the pinchers 2086 apply force on to thelocking wings 2026 and connectors 2034 to cause the clip 2000 to open asit enters the jaws 2042. As the clip advance arm 2084 moves forward ordistally, the clips 2000 and the clip stack move forward under thespring tension from the clip stack pusher 2088 (best shown in FIG. 118).

FIG. 126 illustrates the distal portion 2060 in a cutaway view. Thesecond clip 2000 and is fully advanced into the jaws 2042 by thepinchers 2086 of the clip advance arm 2084. The connectors 2034 areunder pinching pressure from the pinchers 2086 causing the clip 2000 tobe an open position. The upper slanted edge 2012 of the clip 2000 is fitinto a void or pocket that is defined at least in part by the slantededge 2098 of the upper jaw 2044. Similarly the lower slanted edge 2014of the clip 2000 has fit into a void or pocket defined at least in partby the slanted edge 2098 of lower jaw 2046. By retaining the clip 2000in this way, the clip 2000 can be manipulated without coming out of thejaws 2042 at undesired times.

FIG. 127 is an isometric view, FIG. 128 is a side view, FIGS. 129A and129B are front and rear views of a clip pusher 2100 in accordance withanother embodiment of the invention. FIGS. 127-138 illustrate avariation of the embodiments described above. The embodiment shown inFIGS. 127-138 is very similar to the embodiments described above anddiffer in geometry and in operation as described below. Where featuresare not described it may be assumed that the embodiment operates in amanner similar to that described above unless the FIGS. show otherwise.

The clip pusher 2100 includes a spring arms 2102 and projections 2104which may aid in moving the clip pusher 2100 through the feed tube 2076.The projections 2104 may include pushing surfaces 2106, which may beconfigured to push a clip 2000 forward. The clip pusher 2100 includesspring fingers 2108 terminated with projections 2110. In someembodiments of the invention, the projections 2110 aid in limiting themovement of the clip pusher 2100 when it is desired for the clip pusher2100 to remain stationary. In some embodiments of the invention, atcertain times, the projections 2110 will be moved inward by flexing thespring fingers 2108 when it is desired to move the clip pusher 2100. Insome embodiments, the body 2112, the projections 2110, the springfingers 2108, the projections 2104, and the spring arms 2102 may be madeof a single material and are unified. In other embodiments, they may bemade of separate parts. FIG. 129B illustrates a hole 2114 located in thebody 2112 for receiving a clip advance rod 2090 (best shown in FIG.118).

FIG. 130 is an isometric, cutaway view of the distal end 2060 accordingto another embodiment. The feed tube 2076 is shown having slots 2078.The projection 2110 on the spring finger 2108 has stopped the clippusher 2100 from further moving distally or forward. Thus, when thereare no clips 2000 in the feed tube 2076, the clip pusher 2100 will movepartially into the jaws 2042 but will be stopped by the projections 2110(one on each side). The clip advance rod 2090 can be seen attached tothe clip pusher 2100. The spring is not shown in order to avoidovercrowding figure. The jaw boss 2116 is shown with the jaw projection2118 in the jaw boss 2116 providing a camming projection for the jaws2042 when the projection 2118 moves through the actuation slot 2082.

FIG. 131 is a perspective view of a cam finger assembly 2122. The camfinger assembly 2122 includes cam fingers 2124 and cam surfaces 2126.The cam surfaces contact the clip 2000 to push it forward.

FIG. 132 is an isometric, exploded view of the cam finger assembly 2122.The cam finger assembly 2122 includes the cam fingers 2124, and theunified portion 2128. The unified portion 2128 has holes 2129 to acceptfasteners 2134. A cam finger base 2130 attaches to the unified portion2128 and contacts the clip advance arm 2136. The clip advance arm 2136has a notch 2138 for interfacing with the cam finger base 2130. The camfinger base 2130 has a slot 2132 including to larger diameter portions2133. The fasteners 2134 attach the cam finger base 2130 to the unifiedportion 2128 while still being able to slide within the slot 2132. Thelarger diameter portions 2133 may align with the holes 2129 in theunified portion 2128. A cam finger shim 2140 is also shown.

FIG. 133 illustrates the jaws 2042 in an open position. The cam fingers2124 have moved forward and would engage a clip 2000 just behind thehinge portion 2016 and in front of the connectors 2034 to bias the clip2000 and an open position. However, the majority of the clip 2000 itselfis not visible from the view shown in FIG. 133. FIG. 134 illustrates thejaws 2042 and a closed position. The cam finger base 2130 has moved backor proximately as the jaws 2042 closed releasing the cam fingers 2124from the clip 2000 thereby releasing the clip 2000 in the jaws 2042.

FIG. 135 shows the jaws 2042 in a closed position. The cam finger base2130 has moved back pulling the cam fingers 2124 over the clip 2000 justinside the outer tube 2048 and sets into the tabs 2142 in the outer tube2048. FIG. 136 illustrates the jaws 2042 just beginning to open as thecam finger base 2130 moves forward camming the cam fingers 2124 to pinchthe clip 2000 open. The cam fingers 2124 are held in place by the tabs2142 in the outer tube assembly 2048 until the clip 2000 is fullypinched.

The jaws 2042 are in an open position that shown in FIG. 137. Once thejaws 2042 have opened, the cam finger assembly 2122 moves forward. Thecam fingers 2124 push the clip 2000 forward or distally. At the sametime the clip 2000 is pushed into the jaws 2042 and opens as it advancesinto the jaws 2042 and out of the outer tube assembly 2048.

As shown in FIG. 138, the clip 2000 is fully advanced into the jaws 2042by the forward or distal movement of the cam fingers 2124 of the camfinger assembly 2122.

FIGS. 139 through 144 illustrate a handle assembly 2050 that may be usedin accordance with some embodiments of the invention. The handleassembly 2050 is meant to be exemplary only and is in no way limiting.The distal end 2060 (See FIG. 114) of the applier 2040 can be used witha variety of different handle assemblies are not limited to those shownherein. Furthermore, one of ordinary skill the art can appreciate afterreviewing this disclosure that there are many other ways to manipulatethe movements of the distal end 2060. For example, a manually operatedhandle may be used as well as electro/mechanically operated handles,robotically controlled interfaces and other suitable interfaces may alsobe used. Mechanical handles that may be used include not only thevarious mechanical handles illustrated and described in the variousembodiments described herein but other mechanical handles may also beused. While the specific attachments between the handle assemblies 2050in various features of the distal end 2060 are not shown with respect tothe embodiments described FIGS. 139 through 145, these types ofconnections are shown with respect to other embodiments describedherein. Furthermore, other types of these connections may be well knownin the art and may be used in accordance with some embodiments of theinvention. After reviewing the disclosure made herein, one of ordinaryskill the art will understand how to operatively connect the handleassembly 2050 of FIGS. 139-145 to various distal features of the applier2040. FIGS. 139 through 145 show the handle assembly 2050 with one ofthe clamshell housings 2144 removed in order to better show internalparts.

FIG. 139 is an exploded view of a handle assembly 2050. The handleassembly 2050 includes a handle clamshell 2144. It will be appreciatedthat although only one handle clamshell 2144 is illustrated, two handleclamshells are used and are substantially mirror images of each otherwith minor variations to facilitate attaching the two handle shells 2144together or to accommodate interior parts contained in the handle shells2144. The handle assembly 2050 also includes a pivotal trigger 2146. Thepivotal trigger 2146 may include a pivot hole 2166 and connecting ears2164. The handle assembly 2050 may also include a jaw link 2148 and thetrigger link 2150. The handle assembly 2050 may also include a clip lockarm connector 2152 and an advance arm connector 2154. The advance armconnector 2154 may be made of several parts including an arm cap 2156,and arm shaft 2158 and a connector arm housing 2160. The arm cap 2156may include a slot 2157 into which the jaw link 2148 may fit. The armshaft 2158 is fit into the connector arm housing 2160 and both arecapped by the arm cap 2156. The handle assembly 2050 may also include apawl 2162.

FIG. 140 illustrates the start or default position of the components inthe handle assembly 2050. The rotator 2058 allows a user to rotate theouter tube assembly 2048 and thereby the jaws to a desired angularrotation by merely twisting the rotator 2058. The trigger 2146 is shownalong with its pivot point 2168. The trigger 2146 is equipped withconnecting ears 2164 which connect to a clip lock arm connector 2152which is operatively connected to the clip lock arm 2072 (not shown inFIG. 140). The trigger 2146 has a second pivot point 2170. The secondpivot point 2170 is connected to a spring 2172 for biasing the trigger2146 and a trigger link 2150. The trigger link 2150 is connected to thejaw link 2148 within the advance arm connector 2154. The advance armconnector 2154 is operatively connected to the feed tube 2076 (not shownin FIG. 140). The advance arm connector 2154 is capped by the arm cap2156. The spring 2172 urges against the handle shell 2144 on one end andthe advance arm connector 2154 and the clip lock arm connector 2152 atthe other end. The spring 2174 urges against the feed tube 2076 on oneend and the jaw link 2148 on the other end. The springs 2174 and 2176bias the components of the handle assembly 2054 to the position shown inFIG. 140. The pawl 2162 is shown in a disengaged position.

FIG. 141 illustrates the handle assembly where the trigger 2146 is movedslightly the direction indicated by arrow B. The movement of the trigger2146 has caused the jaws 2042 (not shown in FIG. 141) to close. The jawlink 2148 has moved back in the direction illustrated by arrow A toadvance the clip advance arm connectors 2152. The jaw link 2148 pullsback the feed tube (not shown in FIG. 141) through a spring.

As shown in FIG. 142, continued movement of the trigger 2146 in thedirection of arrow B causes the clip advance arm connector 2154 to moveover the pawl 2162 in the direction of arrow A. The trigger link 2150pushes the clip lock arm connector 2152 forward causing the clip lockarm 2072 (not shown in FIG. 142). To move forward and lock the clip 2000contained within the jaws 2042. Continued movement of the trigger 2146in the direction of arrow B the causes the jaw link 2148 within theadvance arm connector 2154 to further compress the spring 2174 therebylimiting the amount of jaw 2042 clamping force. In other words, thespring 2174 is part of an overdrive which limits the amount of closingor clamping force the jaws 2042 can exert. Thus, once the trigger 2146has achieved a particular position, any additional force on the trigger2146 to continue moving in the direction of arrow B will not causeincreased clamping force on the jaws but rather will simply compress thespring 2174.

FIG. 143 shows the trigger 2146 returning to its initial position in thedirection of arrow D. The trigger 2146 returns as result of the biasingfrom spring 2172. While FIG. 143 does not show the lower end of thespring 2172 to anchored, one of ordinary skill the art will understandwhen the second clamshell housing 2244 is installed, the spring 2172will be anchored similar to that shown in FIGS. 144 and 145. The returnmovement of the trigger 2146 causes connecting ears 2164 to move theclip lock arm 2152 in the direction of arrow A. The clip advance arm2154 is locked in place by the pawl 2162. The jaw link 2148 and triggerlink 2150 are moved in the direction of arrow B through the slot 2178 inthe connector housing 2160.

As the trigger 2146 continues to move to its initial condition in thedirection of arrow D, the jaws 2042 (not shown in FIG. 144) open, thepawl 2162 is tripped and the advance arm 2154 moves forward asillustrated by arrow B.

FIG. 145 shows the components at their initial conditions. The trigger2146 is at its full forward position the clip 2000 and loaded into thejaws 2042 (not shown in FIG. 145) the advance arm connector 2154 is inits initial condition along with the trigger link 2150.

FIGS. 146-148 illustrate another clip 2000 that may be used in someembodiments of the invention. The clip 2000 shown in FIGS. 146-148 issimilar to the clip illustrated in FIGS. 108-113. Differences betweenthe clip 2000 shown in FIGS. 146-148 include the buttress 2022 having adifferent exterior geometry. The buttress 2022 is attached theconnectors 2034 which, in turn, are connected to the locking wings 2026of the clip 2000. The locking wings 2026 have a slightly differentgeometry as the clips 2000 shown earlier figures but is shaped tocorrespond to the exterior geometry of the buttress 2022. The differentexterior geometry of the buttress 2022 provides desired locking andunlocking characteristics for facilitating insertion or removal of thebuttress 2022 from the locking void 2020. The clip 2000 also has bulges2180 mounted on the upper leg 2002 and the rear bottom leg 2004. In someembodiments, the bulges 2180 assist in the retention and removal of theclip 2000 in the jaws 2042 of the applier 2040. In other embodiments ofthe invention appliers 2040 can be used with various shaped clips andare not limited to the various clips described herein. For example,other clips are shown and described in the application titled “NarrowProfile Surgical Ligation Clip” filed Sep. 14, 2012 and identified asU.S. patent application Ser. No. 13/616,120 which is incorporated byreference in its entirety herein.

The many features and advantages of the invention are apparent from thedetailed specification, and, thus, it is intended by the appended claimsto cover all such features and advantages of the invention which fallwithin the true spirit and scope of the invention. Further, sincenumerous modifications and variations will readily occur to thoseskilled in the art, it is not desired to limit the invention to theexact construction and operation illustrated and described, and,accordingly, all suitable modifications and equivalents may be resortedto that fall within the scope of the invention. All ranges cited hereinspecifically incorporate all values and sub-ranges within the citedrange.

What is claimed is:
 1. A method of applying a ligation clip comprising:sliding a feed tube forward thereby camming a projection on a jaw tomove the jaw to an open position; sliding a clip arm forward therebypushing a clip into the jaws; sliding the feed tube rearward therebycamming the projection on the jaw to move the jaw to a closed position;and advancing a clip arm to a forward position to push a buttress on theclip into a buttress locking void thereby locking the clip and a closedposition.
 2. The method of claim 1, further comprising storing a stackof clips in the feed tube wherein the clips are in a semi-closed state.3. The method of claim 1, further comprising actuating the feed tubewith a lever and once the feed tube has moved rearward to close thejaws, diverting any additional force applied on a lever to a springthereby limiting the closing force of the jaws.
 4. The method of claim1, further comprising opening the clip as it enters the jaws.
 5. Themethod of claim 1 further comprising, advancing a clip stack pusher intothe jaws once there are no more clips in the feed tube.
 6. The method ofclaim 1, wherein the method is accomplished by using an applier for aligation clip comprising: an outer tube having mounting bosses, themounting bosses defining holes; a pair of jaws pivotally connected tothe mounting bosses, the jaws having outwardly extending projectionsthat extend through the holes in the bosses and inwardly extendingactuating projections; a feed tube located in the outer tube andconfigured to move axially within the outer tube, the feed tube havingactuating slots into which the actuating projections extend; a clip lockarm located in the outer tube and configured to move axially within theouter tube; and a clip advance arm located in the outer tube andconfigured to move axially within the outer tube, the clip advance armhaving flexible pinchers at one end of the clip advance arm.
 7. Themethod of claim 6, wherein the applier is actuated by a trigger.
 8. Themethod of claim 1, further comprising securing the clip in the jaws withfeatured located in a distal end of the jaws.
 9. The method of claim 8,wherein the feature is a recess.
 10. The method of claim 1, furthercomprising positing the jaws and a clip over a structure to be ligated.11. The method of claim 1, further comprising closing the jaws and clipover the structure to be ligated.
 12. The method of claim 1, wherein themethod is accomplished by using an applier for a ligation clipcomprising: an outer tube having mounting bosses, the mounting bossesdefining holes; means for clamping pivotally connected to the mountingbosses, the means for clamping having outwardly extending projectionsthat extend through the holes in the bosses and inwardly extendingactuating projections; means for opening and closing the means forclamping located in the outer tube and configured to move axially withinthe outer tube, the means for opening and closing the means for clampinghaving actuating slots into which the actuating projections extend;means for locking a clip in closed position located in the outer tubeand configured to move axially within the outer tube; and means foradvancing a clip located in the outer tube and configured to moveaxially within the outer tube.
 13. A method of closing a clip with anactuator comprising: storing a clip in a tube; biasing the clip to adistal end of the actuator having a jaw; moving the tube forward andthereby open the jaw; moving the clip into the jaw; closing the jaw; andmoving a buttress portion of the clip into a buttress locking voidthereby locking the clip in a closed position.
 14. The method of claim13, further comprising securing a clip in the tube with a spring fingeron the tube.
 15. The method of claim 13, closing the clip with flexiblepinchers on the applier.
 16. The method of claim 13, further comprisingpivotally connecting the jaw to an outer boss of the applier with apivot pin.
 17. The method of claim 13, wherein the tube storing the clipis an inner tube contained by an outer tube.
 18. The method of claim 17,wherein the inner tube is configured to move with respect to the outertube.
 19. The method of claim 13, further comprising moving the cliplocking buttress with a clip lock arm.
 20. The method of claim 13,further comprising opening the clip when it moves into the jaw.